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Medical Management
Provides information management services to the Medical Management Department by researching and reviewing claims; resolving customer service problems; and triaging and indexing all medical records. Also assists with the substantive work of the Medical Management department, including making determinations on prior authorization issues not requiring clinical review.
Key Task
Researches, reviews and resolves claims and benefit questions with Customer Service and other Operations areas. Reviews requests using a defined, approved script. Determines appropriateness of request, or, as necessary, refers to clinical staff for review and certification of medical appropriateness. Performs all duties in a manner consistent with the company’s Code of Conduct and policies and procedures and other related duties as assigned to meet departmental and company objectives.
Key Skills
Associate’s degree from a college or university in business administration, health care management, or other relevant academic field or three (3)years of experience in positions providing intimate familiarity with medical terms; or any combination of education and experience providing the types and levels of knowledge, skills, and abilities required by the job
Who are your employers?
Any company in the insurance industry.
