Inbound Call Center Agent - Insurance Pre-Authorization
About the position
As an Inbound Call Center Agent specializing in Insurance Pre-Authorization, you will assist members and health providers with the creation of prior authorizations and review pending statuses. This role is crucial in enrolling members into various health programs and ensuring they have access to necessary services. The position is remote, requiring availability for an 8-hour shift from Monday to Friday, between 7 am and 7 pm CST.
Responsibilities
Work with members and health providers for Prior Auth creation and review pending statuses.
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Enroll members into CMC programs such as cancer, kidney, artificial hearts, ortho, etc.
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Review member policies for access and qualifications.
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Inform members about available programs and set up appointments with providers.
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Ensure cases are set up correctly and document required information.
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Review, research, and determine if cases can be decisioned or require additional clinical review.
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Make outbound calls to providers and/or members to obtain information regarding cases as needed.
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Coordinate provider availability in treating members as needed.
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Perform other duties as assigned by manager and/or director.
Requirements
Minimum of a High School Diploma / GED.
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1+ years of professional experience in a medical or health insurance environment.
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Prior customer service experience making outbound calls.
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Proficiency in using a computer.
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Experience with Microsoft Office Products including Outlook, Word, and Excel.
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Ability to work an eight (8) hour shift Monday-Friday between 7am-7pm CST.
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Flexibility to work outside standard hours due to changing business needs.
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Ability to troubleshoot and set up computer equipment independently.
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Must have a designated work area that is separate from other living areas and can be secured to maintain PHI or PI security in line with HIPAA policies.
Nice-to-haves
Previous experience working with back office medical platforms and/or authorizations systems.
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Experience in the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting.
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Knowledge of Medical Terminology, ICD-10 and CPT codes, Medicare and/or Medicaid Services.
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Professional experience in a Clerical or Administrative support role.
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Ability to quickly learn various computer systems or applications.
Benefits
Competitive pay and day one benefits.
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Opportunities for career advancement.
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Health Insurance options.
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401K Plan with matching contributions.
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Paid Time Off (PTO) including national holidays.
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