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Telligen · 20 hours ago

Review Assistant

Mississippi, United States

Full-time

Onsite

Entry Level

2+ years exp

Telligen is one of the most respected population health management organizations in the country. The Review Assistant position is responsible for facilitating case review activities, including communication and data integrity support, while ensuring compliance with established guidelines and providing quality customer service.

Health Care

Culture & Values

No H1B

Responsibilities

You will interpret 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

You will coordinate, distribute and tracks highly confidential medical information from multiple sources (fax, web, and phone)

You will interpret and adhere to URAC standards for assigned programs as well as federal and state requirements

You will escalate issues through appropriate channels, following established hierarchical protocols between clinical and non-clinical staff members

You will ensure quality customer service by responding to phone inquiries from members, physicians, and providers. Prioritize workload to meet program or regulatory time frames

You will provide verbal and written communications of review decisions to include administrative denials. Complete service/treatment screens for accurate transmission of outcome decision

You will effectively guide members to appropriate member benefit information

You will provide general office support and performs miscellaneous duties as assigned

Qualification

Customer service experienceHealthcare environment experienceMedical terminologyVerbal communicationWritten communicationPC skillsDeadline drivenConfidential information handling