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Receives inbound calls from providers to determine authorization requirements, answer general questions and/or submit authorization requests for services rendered. Receives faxed authorization requests and performs data entry functions to submit requests for review. Complies with organizational policies and procedures, regulatory requirements, and other established criteria and guidelines. Maintains confidentiality of business and protected health information. Performs other data entry, administrative support, reporting and other related tasks, as-needed.
Answers telephones according to established grade of service standards
Collects and verifies information concerning member eligibility, provider status, authorization requirements and authorization status
Provides customer service functions to help coordinate member needs
Performs data entry of authorizations in the electronic medical management system
Conducts outbound calls to follow up on inquiries related to the member and/or authorization process as-needed
Assists in preparing and submitting projects, reports or assignments as-needed to meet organizational initiatives and/or objectives
Adheres to standard metrics for quality, production and average call handling time
Communicates authorization specific to providers either verbally on the phone calls or written through fax
Performs other duties as assigned.
Required A High School or GED
Required 1 year of experience in customer service experience
Preferred Other Call Center experience
Beginner Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
Intermediate Ability to work as part of a team
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Other Type 40 wpm
Licenses and Certifications: A license in one of the following is required: