clinical support - utilization management.
boston , massachusetts (remote)
posted today
job detailssummary
$23 - $25 per hour
temp to perm
high school
category healthcare support occupations
referenceAB4543844
job detailsQualifications:
Associate or High School Diploma degree required.
Health care delivery, medical billing, coding and/or customer service experience.
Knowledge of utilization management process (i.e., Health Center, Hospital, Insurance Company, Physician office)
Knowledge of Utilization Management regulations and standards
Experience with Medicare, Medicaid, and Commercial lines of business
bilingual preferred.
salary: $23 - $25 per hourshift: Firstwork hours: 8 AM - 5 PMeducation: High SchoolResponsibilities
Provide support to UM Care Managers to ensure provider and member customer satisfaction.
Process authorizations and referrals using desktop procedures and workflows
Outreach providers for needed clinical information and upload to appropriate authorization in Mass General Brigham Health Plans' online provider portal
strong knowledge and understanding of processing requests per Medicare, Medicaid, andcommercial lines of business
Meet quality standards per NCQA, CMS, DOI, and health plan regulations
Ensure customer satisfaction to providers and members
Respond in a timely and accurate manner to internal and external customer inquiries as per policies and procedures. Escalate urgent issues as appropriate.
Achieve and maintain compliance with telephone accessibility
Skills
Authorizations
Referrals
Medical Billing
medical coding
utilization management
medicare/medicaid
Spanish
Qualifications
Years of experience: 0 years
Experience level: Entry Level
Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [email protected] offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility).Applications accepted on ongoing basis until filled.get in touchwe are here to help you with your questions.SDsamantha dougherty