About the role Receive inbound calls, faxes, and web requests from providers and/or clients Initiate and facilitate the authorization process in accordance with established health plan policies and procedures Document demographic information obtained from telephonic, fax, or emailed requests within the care management system Make outbound calls to follow up on discharge information or request updated clinical information as necessary for concurrent review Screen inquiries to determine the services that require certification at the time of the inquiry Obtain clinical information and forward the caller to the clinical staff for completion of the review Provide certification based upon scripted clinical algorithms or benchmark Length of Stay Collaborate and effectively communicate with internal and external partners Stay up to date on Summary Plan Documents and other related resources related to service requests Ensure applicable URAC standards, Confidentiality/HIPAA standards, and internal policies, practices, and productivity metrics are met Performs other related duties as assigned by supervisor Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties. Requirements 2+ years of experience in high-volume call center or customer support environment High attention to detail while maintaining courteous, accurate, and timely relations with our partners and members Strong problem solving skills Excellent communication skills, both verbal and written GED or High School Diploma Fluent in reading, writing, and speaking Spanish and English A plus if you have: Medical, claims, or collection call center experience. Medical Terminology Certification Microsoft Office Suite experience Competitive benefits package with generous employer subsidies Flexible and remote working options 401k with generous employer match and immediate vesting Personal and professional development opportunities Supportive family benefits, including paid leave for new family members Companywide philanthropic program, Valenz Communities Connection Copy Applicant Tracking System Keywords Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills medical terminology call center experience customer support clinical information review authorization process documentation certification problem solving bilingual communication
Soft skills attention to detail courtesy timeliness communication collaboration
Certifications Medical Terminology Certification GED High School Diploma