Perform duties to assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.
High school diploma or equivalent; 2-3 years managed care or physician’s office experience. Thorough knowledge of customer service, utilization review or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology.
• Initiate authorization requests for output or input services in keeping with the prior authorization list. Maintain integrity of PHI. Maintain working relationships with other departments. Research claims inquiry specific to the department and responsibility. Attend ongoing training and in-services as directed.
• Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census.
• Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Answers phone queues and faxes within established standards. Screen members by priority for CM assessment.
• Coordinates services with community based organizations. Attends marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material.
• Data enters assessments and authorizations into the system. Maintains database as directed.
Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...