Medical Insurance Verifier
Are you looking to get back to work? Do you have experience with medical terminology and coding? We need you!
Randstad is hiring a Utilization Management Assistant or Medical Insurance Verification Specialist to work with our client a major healthcare provider network in Hesperia.
This is a great company to work for with lots growth potential.
Responsible for verification of member's eligibility and checks benefits of members for services requested per evidence of coverage guidelines.
Performs preliminary review and assessment of referrals for completeness: Supporting clinical documentation for the referral request, ICD-10, CPT, or HCPC codes. Assists in gathering clinical information needed to substantiate the medical necessity of the requested referrals.
Referrals HMO as well as Non-HMO will be processed according to the established SJHH internal process (electronic submission when applicable) utilizing contracted vendors/providers as determined by the Contracting Department and Leadership with an accuracy rate of 98%.
Maintains files and documentation with an accuracy rate of 95% or greater according to UM departmental standards.
Communicates with physician offices, processing staff, and other departments as needed to ensure collaboration and open discussion regarding the referral process. This includes responding to messages within the next business day with a compliance rate of 90% or greater.
Assists in the denial letter process under the direction of the nurse reviewer, UMA Lead, or Supervisor when appropriate. Initiates Information Member Notice based on benefit or eligibility.
Working hours: 8:00 AM - 5:00 PM
1yr - Experience in utilization management or case management with experience in medical terminology and coding.
1yr - Experience in a hospital, health insurance company or medical office/clinic setting
exp. in coding is a plus
High School diploma/GED
If you are interested please APPLY NOW!
For more immediate consideration please email a current resume to firstname.lastname@example.org
Thanks for your interest in working with Randstad, the world's largest staffing company in the world!
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