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Care Review Processor II

Location : Hidalgo County, TX
Job Type : Contract
Reference Code : 13185
Hours : Full Time
Required Years of Experience : 2-4
Required Education : HS Diploma or GED
Travel : No
Relocation : No
Job Industry : Healthcare - Health Services
Job Category : Healthcare - Support Services

Job Description :

We have immediate openings for REMOTE Care Review Processors to join our team in the Hidalgo County, TX area! **PLEASE NOTE: candidates MUST HAVE 2-4 years of current or recent utilization review or case/care management experience, 1+ years current or recent experience in a Customer Service Call Center and/or Medical Insurance background, and must reside in or near Hidalgo County to qualify - no exceptions! This is a fully remote, 6-month, contract-to-hire position.


 


The Care Review Processor Works within the Care Access and Monitoring (CAM) team to provide clerical and data entry support for members that require hospitalization and/or utilization review for healthcare services. Provide computer entries of authorization request/provider inquiries by phone, mail, or fax. Verify member eligibility and benefits, determine provider contracting status and appropriateness. Determine diagnosis and treatment requests, assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes), and determine COB status to ensure delivery of high quality, cost-effective healthcare services according to State and Federal requirements.

Salary:
Up to $19/hr (based on experience)

Hours/Shifts:
Full-time; 40 hrs/week

Required Experience:
- 2-4 years current or recent utilization review or case/care management experience in a managed care environment
- 1+ years current or recent experience in a Customer Service Call Center and/or Medical Insurance background
- Typing/data entry minimum of 40 WPM
- Proficient computer skills
- Proficiency with Microsoft Office applications


Required Qualifications :
Required Experience:
- 2-4 years current or recent utilization review or case/care management experience in a managed care environment
- 1+ years current or recent experience in a Customer Service Call Center and/or Medical Insurance background
- Typing/data entry minimum of 40 WPM
- Proficient computer skills
- Proficiency with Microsoft Office applications



Required Education:
- HS Diploma or GED
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