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Resp & Qualifications

PURPOSE:

Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality of care in a call center environment and/or fax unit. We are looking for an experienced professional to work remotely from within the greater Baltimore/Washington metropolitan areas. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

ESSENTIAL FUNCTIONS:

• Performs member or provider related administrative support which may include benefit & eligibility verification, authorization creation management and case documentation while adhering to TAT.

• Reviews authorization requests for initial determination and/or triages for clinical review and resolution. Will approve requested services based on established criteria.

• Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, managing escalations and correspondence, researching information and assisting in solving problems.

• Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.

QUALIFICATIONS:

Education Level: High School Diploma or GED.

Experience: 3 years' experience in health care services or office support and/or call center environment.

Preferred Qualifications :

• Two years' experience in health care/managed care setting or previous work experience within division.

• Knowledge of CPT and ICD-10 coding.

Knowledge, Skills and Abilities (KSAs)

• Ability to effectively participate in a multi-disciplinary team including internal and external participants.

• Excellent communication, organizational and customer service skills.

• Knowledge of basic medical terminology and concepts used in managed care.

• Knowledge of standardized processes and procedures for evaluating medical support operations business practices.

• Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy.

• Ability to pay attention to the minute details of a project or task.

• Experienced in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point.

Salary Range: $35,280 - $64,680

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Non-Clinical (Phones and Faxes)

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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REQNUMBER: 20724