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Care Review Processor

Location : Louisville, KY
Job Type : Contract
Reference Code : 14939
Hours : Full Time
Travel : No
Relocation : No
Job Industry : Healthcare - Health Services
Job Category : Healthcare - Support Services

Job Description :

Large healthcare organization has openings for some Care Review Processors to work at their facility. For these positions you can be located in Kentucky or Illinois. This contract position has growth opportunity and pays $16.50/hr.


Summary


 


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 other healthcare services. The Processor checks eligibility and verifies benefits, obtains and enters data into systems, processes requests, and triages members and information to the appropriate Health Care Services staff to ensure the delivery of high quality, cost-effective healthcare services according to State and Federal requirements to achieve optimal outcomes for Members.


 


The Care Review Processor duties include (but are not limited to) the following:



  • 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 submitted to CAM via phone, fax and mail according to operational timeframes. •

  • Participates in interdepartmental integration and collaboration to enhance the continuity of care for Members including Behavioral Health and Long Term Care.

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


For immediate consideration please email sroper@mednationalstaffing.com


Required Qualifications :
 
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