Review Assistant II

Telligen•West Des Moines, IA

About The Position

This position is responsible for inbound and outbound communication in support of case review activities including collection and confirmation of data integrity in support of clinical review services.

Requirements

High school diploma or equivalent
Minimum 2 years of experience working in a customer service or healthcare environment
Minimum 2 years of experience with data entry
Demonstrated ability to work with confidential information and maintain strict confidentiality
Proven ability to work effectively in a deadline-driven environment
Excellent written and verbal communication skills
Intermediate PC/computer skills
Ability to work independently with minimal supervision
Able to travel throughout the Des Moines metro area, reliable transportation required for local travel

Nice To Haves

Experience in a health care environment
Experience in Iowa Medicaid
Experience in working remotely
Satisfactory completion of medical terminology course

Responsibilities

Interpret review guidelines to facilitate forward movement of the case review process including requests for clinical information, treatment plans, discharge dates and communicating the authorization for requested services.
Coordinate, distribute and track highly confidential medical information from multiple sources (fax, web, and phone).
Interpret and adhere to URAC standards for assigned programs as well as federal and state requirements.
Ensure quality customer service by responding to phone inquiries from members, physicians, and providers. Prioritize workload to meet program or regulatory time frames.
Provide verbal and written communications of review decisions to include administrative denials.
Complete service/treatment screens for accurate transmission of outcome decision.
Provide general office support and perform miscellaneous duties as assigned.

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