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Care Review Processor

Location : Long Beach, CA
Job Type : Contract to Direct
Reference Code : 7607
Hours : Full Time
Required Years of Experience : 5-7 of Utilization Review
Required Education : High School Diploma or Equivalent
Travel : No
Relocation : No
Job Category : Healthcare - Medical Records

Job Description :
Our client, a huge Healthcare company, is seeking a Care Review Processor in Long Beach CA!

 

Shift:10am-6:30pm after training. May be required to work weekends/holidays as needed!

 

Care Review Processor Job Responsibilities: 



  • To provide clerical and data entry support for members that require hospitalization and/or utilization review for other healthcare services. 

  • Checks eligibility,verifies benefits, obtains and enters data into systems, processes requests, and triages members and information to the appropriate Health Care Services staff.

  •  Provide computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: 

  • Verify member eligibility and benefits, 

  • Determine provider contracting status and appropriateness,

  • Determine diagnosis and treatment request  

  • Assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes), 

  • Determine COB status,

  • Verify inpatient hospital census-admits and discharges, 

  • Perform action required per protocol using the appropriate Database. • 

  • Respond to requests for authorization of services • . • 

  • Contact physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director. • 

  • Provide excellent customer service for internal and external customers. • . • 

  • Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status.• 


Required Qualifications :
Care Review Processor Job Requirements:






 



  • Working knowledge of medical terminology and abbreviations. • 

  • Ability to think analytically and to problem solve. •  • 

  • Must have a high regard for confidential information. •  • •

  • Computer skills and experienced user of Microsoft Office software. • 

  • Accurate data entry at 40 WPM minimum.  

  • Previous Hospital or Healthcare clerical, audit or billing experience. 




 

 

For immediate consideration, please email resume to jneary@mednationalstaffing.com
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