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Health Care Review Processor

Location : REMOTE/Texas
Job Type : Internal Temp/Contract
Reference Code : 21012
Hours : Full Time
Required Years of Experience : 2+
Required Education : High School Diploma or Equivalent
Travel : No
Relocation : No
Job Category : Healthcare - Medical Records

Job Description :
Large healthcare organization has openings for Health Care Review Processors to support their Care Access & Monitoring team in Dallas and San Antonio, TX. 

  



This is a contract opportunity currently budgeted at 6 months with possibility of extension and a starting pay rate of $17/hour.



This is a REMOTE position, however, candidates will be required to attend meetings onsite occasionally once the offices are fully reopened. Only candidates local to the San Antonio, Dallas, or El Paso, TX, area will be considered for this role. 






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. 




 


Available Shifts




Sunday-Thursday 9 am -6 pm 


Monday-Friday 11 am - 8 pm


 

 

Required Qualifications :

Required Education



  • High School Diploma/GED


 


Required Experience



  • 1-3 years of experience in a Utilization Review Department in a Managed Care Environment.  

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

  • Experience with Medical Terminology.


 


Knowledge/Skills/Abilities



  • Demonstrated ability to communicate, problem solve, and work effectively with people.  

  • Working knowledge of medical terminology and abbreviations. 

  • Computer skills and experienced user of Microsoft Office software. 

  • Accurate data entry at 40 WPM minimum.


 


 


 


 


 


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