Call Center Representative
CareCore National - Bluffton, SC

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Company Overview CareCore National, a specialty benefit management company, manages quality and utilization of outpatient diagnostic and cardiac imaging, cardiac implantable devices, oncology drugs and therapeutic agents, radiation therapy, sleep, pain and lab services. With a comprehensive and diverse portfolio of offerings, we provide seamless solutions to health plans that seek to manage these specialty health care segments more effectively.

Our Focus
CareCore National provides physicians with access to the latest evidence-based criteria and works collaboratively with providers to improve the way care is delivered to patients. We focus on appropriateness to ensure that health plan members receive the right procedure for their clinical situation. We achieve this by employing state-of-the-art technology and evidence-based criteria. All CareCore National programs improve quality, streamline patient care and reduce cost.

Job Description
  • Processes clinical certification requests for radiological services from physician offices and/or imaging centers, collecting demographic information and entering data.
  • Performs focused screening processes that do not require clinical review and/or clinical judgment.
  • Trained in pre-certification, utilization management, NCQA and URAC principles, policies, and procedures
  • Processes review of service request notifications that do not require certification of medical necessity
  • Promptly transfers a telephone call for review of services to a clinical first level reviewer or medical reviewer if the review cannot be completed based on a formal script
  • Prepares program correspondence as needed
  • Performs various clerical functions
  • High School graduate or higher education
  • Call Center Experience preferred
  • Previous medical office environment experience preferred
  • Experience with computer data entry, customer service, medical terminology, or managed care is preferred
  • Must type 30 WPM or more and have good active listening skills

CareCore National - 21 months ago - save job
About this company
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Since 1994, CareCore National has provided comprehensive, customized programs to health plan clients that seek to manage appropriate...