Integrated Resources INC
UM / Data Entry Tech
Des Moines, IA, United States
Sponsorship not specifiedDetected 3234 days ago
Communication
About the role
- - Screens information received and refers members to the appropriate provider and/or contacts the provider directly for members.
- - Facilitates the authorization process for requests that do not require clinical criteria application or judgment.
Responsibilities
- Refers unresolved prior authorization process questions to the Lead Intake Specialist.
- Assists the Lead Intake Specialist in identifying, planning and implementing staff training programs.
- Supports Utilization Management nurses with data entry.
- Performs other duties as assigned.
Requirements
- Proven ability to keep accurate and timely records and documentation according to established processes
- Experience handling multiple calls or triaging calls
- Ability to write clear and concise reports.
Benefits
- Identifies and reports member and provider educational opportunities to the Lead Intake Specialist.
- Accurately answers questions regarding Plan benefits and Utilization Management requirements for members and providers.
- Makes appropriate inquiries to determine potential coordination of benefits and advises appropriate provider and claims staff of same.
- Adheres to Select Health and KMHP policies and procedures.
- Supports and carries out the Select Health and Mercy Mission & Values.
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