Telligen · 5 days ago
Review Assistant
Ridgeland, MS
Full-time
Hybrid
Entry Level
2+ years expTelligen is one of the most respected population health management organizations in the country, dedicated to transforming lives and economies by improving health. The Review Assistant position is responsible for supporting case review activities through communication, data integrity, and customer service, while adhering to regulatory standards.
Health Care
No H1B
Responsibilities
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
Coordinate, distribute and track highly confidential medical information from multiple sources (fax, web, and phone)
Interpret and adhere to URAC standards for assigned programs as well as federal and state requirements
Escalate issues through appropriate channels, following established hierarchical protocols between clinical and non-clinical staff members
Ensure quality customer service by responding to phone inquiries from members, physicians, and providers. Prioritize workload to meet program or regulatory time frames
Provide verbal and written communications of review decisions to include administrative denials. Complete service/treatment screens for accurate transmission of outcome decision
Effectively guide members to appropriate member benefit information
Provide general office support and perform miscellaneous duties as assigned
Qualification
Required
High school diploma or equivalent
2 years of experience working in a customer service or healthcare environment
Demonstrate ability working with confidential information and in a deadline driven environment
Excellent verbal and written communication skills and intermediate PC skills
Preferred
Experience in a health care environment
Medical terminology experience
Company
Telligen
Telligen is a trusted partner for U.S. government health agencies.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
RheaAnn Frost-Clewell
Vice President Finance & Administration/CFO
Brian Barry
Vice President - Enterprise Solutions & CIO
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