Typical Job Duties and Responsibilities:
- Validate the request submitted via the Comagine Health Provider Portal for accuracy and completeness.
- Screen requests for required clinical information based on type of request, determining if information is sufficient for clinical review.
- Obtain clinical information from the client systems when indicated or contact provider to obtain information required for review.
- Process requests after physician review, evaluating language and working with physician reviewers, clinical reviewers, or managers to ensure language and determination information is complete before sending letters to providers.
- Respond to inbound telephone requests with clear documentation in the care management system.
- Enter case information from original source documentation or validate information entered by providers in the portal.
- Provide notification of completed review and additional information needed, when applicable.
- As requested, contribute to orientation and training of other non-clinical employees.
- As requested, create templates for complex reviews, perform internal quality reviews, and/or participate in provider outreach activities.
- May perform scripted non-clinical reviews and refer reviews requiring further action to clinical review staff
- After physician review, notify providers of decertification or potential denial of services by phone or in writing as required by contract.
- Intermediate understanding of medical terminology.
- Intermediate MS Office Suite proficiency.
- Demonstrated proficiency with medical terminology.
- Participates in orientation and training of other Intake staff.
- High school diploma or equivalent (equivalent combination of education and/or work experience in related field may be substituted).
- 2 years of related work experience or customer service experience.
- 1 year of work experience in healthcare.
Candidates should ideally reside within Pacific Time Zone or Mountain Time Zone.
- 2 years of work experience in healthcare; nursing assistant or medical assistant experience.
- Post-secondary education or certification in a health care related field.
Salary Range: $17.50 – $24.00 per hour