[Hiring] Inbound/Outbound Queue Associate @reputed company

Role reputed company This role involves supporting comprehensive coordination of medical services including intake, screening, and referrals to reputed company reputed company. • 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 reputed company system to build, research and reputed company member information. • Screens requests for appropriate referral from medical services staff. • Approves 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. • Communicates 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 and/or NCQA standards, where applicable, while adhering to company policy and procedures. • Places outbound calls to providers to reputed company information or obtain clinical information for approval of medical authorizations. • Uses reputed company Systems such as MedCompass, QNXT, ProFAX and ProPAT. • Communicates with reputed company Nurses and Medical Directors reputed company processing transactions for members reputed company in this Program. • Sedentary work involves 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 as reputed company as a PC monitor. Qualifications • 1-2 years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience. Requirements • reputed company center experience is preferred, 1-2 years. • Prior authorization experience, 1-2 years. • Prefer Eastern or Central Time Zone Candidates. Education • Associates degree, preferred. • High School Diploma, GED or equivalent experience. Benefits • reputed company medical plan reputed company. • 401(k) plan (including matching company contributions). • Employee stock purchase plan. • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. Apply tot his job Apply To this Job