Review Assistant/CSR

Essential Functions

• • Interprets review guidelines to facilitate forward movement of the case review process including requests for clinical information, treatment plans, discharge dates, and communicating the authorization for requested services.
  • Coordinates, distributes, and tracks highly confidential medical information from multiple sources (fax, web, and phone). Interprets and adheres to URAC standards for assigned programs as well as federal and state requirements.
  • Ensures quality customer service by responding to phone inquiries from members, physicians, and providers. Prioritizes workload to meet program or regulatory time frames.
  • Provides verbal and written communications of review decisions to include administrative denials. Completes service/treatment screens for accurate transmission of outcome decisions.
  • Provides general office support and performs miscellaneous duties as assigned

Requirements

• • High school diploma or equivalent
  • 2 years experience working in a customer service or healthcare environment
  • Demonstrated ability working with confidential information and in a deadline-driven environment
  • Excellent verbal and written communication skills and intermediate PC skills.
  • Must reside in central Iowa with the ability to work on-site one day per month.
  • Experience in a healthcare environment preferred.
  • Satisfactory completion of medical terminology course preferred.
  • Intermediate PC functions preferred.