Job Details

Overview:

TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.

Title: Clinical Support Representative

Work Location: Berlin, VT

Duration: 3 Months

Job Type: Contract

Work Type: Remote

Dept: Healthcare Informatics, Reimbursement and Management / Utilization Management

Engagement Description:

• The Clinical Support Representative's primary responsibility is to facilitate and coordinate preadmission/admission reviews, prior approvals and referral requests through the medical review cycle in compliance with Rule 10, DOL (department of labor), NCQA (National Committee for Quality Assurance), and URAC (Utilization Review Accreditation Commission) timeliness requirements.
• This includes generating and performing quality assurance of correspondence, entering authorizations to ensure appropriate claims processing, and maintaining electronic medical records.
• The Clinical Support Representative is also responsible for answering department phone calls and evaluating issues and questions from internal and external customers.
• The Representative provides exceptional customer service when interacting with all internal and external customers and always maintains the highest level of confidentiality.

• Subject Matter Expertise
  • Understanding of plan benefits and products
  • Understanding of claims adjudication and data systems
  • Understanding of medical terminology and medical coding, to include ICD-9, HCPCS, and CPT4
  • Understanding of URAC, NCQA, Rule 10, DOL, and other regulatory standards pertaining to Case/Care Management
• Computer Skills- Competent in use of MS Office Applications (specifically Outlook, Word and Excel), AS400 legacy, MHS, Lotus Notes, Customer Focus, OnBase, The Knowledge Center, FEP Direct, web browsing, Acuity and phone system.
• Communication Skills - Strong written and oral communications skills, with advanced listening skills to be able to identify provider and subscriber concerns

• 1-3 years' experience in the healthcare industry, preferably health insurance.
• Interpersonal Skills - Strong interpersonal skills, including the ability to effectively maintain a consistently pleasant, courteous, and positive manner in responding to all subscriber and provider telephone inquiries, including those from angry or difficult customers
• Organizational Abilities - Strong organizational skills, including the ability to work independently, demonstrate attention to detail with accuracy, utilize resources, and manage/prioritize increasing volume within quality standards.
• Analytical Skills - Strong analytical skills, including research and analysis

• Experience in health insurance claims processing

• High School Diploma
• Associates Degree preferred