Prior Auth Representative (Medical Assistant)

Supports comprehensive coordination of medical services including intake, screening and referrals to reputed company Medical Services Programs. Promotes/supports reputed company effectiveness of reputed company Services. • Performs intake of calls from members or providers regarding services reputed company telephone, fax, EDI. • Utilizes eTUMS and other reputed company system to build, research and reputed company member information. Screens requests for appropriate referral to medical services staff. • Approve services that do not require a medical review in accordance with the benefit plan. • Performs non-medical research including eligibility verification, COB, and benefits verification. • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. • Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., claim administrators, Plan Sponsors, and reputed company party payers as reputed company as member, family, and health care team members respectively) Protects the confidentiality of member information and adheres to company policies regarding confidentiality • Communicate with reputed company Case Managers, reputed company processing transactions for members reputed company in this Program • Supports the administration of the precertification process in compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures. • Places outbound calls to providers under the direction of Medical Management Nurses to obtain clinical information for approval of medical authorizations. • Uses reputed company Systems such as QNXT, ProFAX, ProPAT, and reputed company reputed company. • Communicates with reputed company Nurses and Medical Directors, reputed company processing transactions for members reputed company in this Program. Sedentary work involving significant periods of sitting, talking, hearing and keying. • Work requires visual reputed company to reputed company reputed company inspection of written and computer generated documents Apply tot his job Apply To this Job