SUMMARY
· Responsible for coordinating cases for precertification and prior authorization review.
MAJOR JOB DUTIES AND RESPONSIBILITIES: Primary duties may includes, but are not limited:
· Managing incoming calls or incoming post services claims work.
· Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
· Refers cases requiring clinical review to a Nurse reviewer.
· Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
· Responds to telephone and written inquiries from clients, providers and in-house departments.
· Conducts clinical screening process.
· Authorizes initial set of sessions to provider.
· Checks benefits for facility based treatment.
· Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
EDUCATION/EXPERIENCE
· Requires High school diploma
· 1 year of customer service or call-center experience; proficient analytical, written and oral communication skills; or any combination of education and experience, which would provide an equivalent background.
· Medical terminology training and experience in medical or insurance field preferred.
Required education: HS Diploma
Top 3 Must-Haves:
1. Call Center
2. Medical terminology
3. Good Tenure
Why Kelly?
As a Kelly Services candidate you will have access to numerous perks, including:
Exposure to a variety of career opportunities as a result of our expansive network of client companies
Career guides, information and tools to help you successfully position yourself throughout every stage of your career
Access to more than 3,000 online training courses through our Kelly Learning Center
Group-rate insurance options available immediately upon hire*
Weekly pay and service bonus plans
Job details are sourced from the employer's original posting.
Open job postingAbout the company
Kelly Services is looking to hire several Site Logistics Operators/Material Handlers in Knoxville, TN for an industry leading chemical company. For this opportunity, you could be placed as a Chemical Finished Product Operator or a Polymers Packaging/Warehousing/Shipping Operator on a long-term, indefinite assignment. You will be working with chemicals and should be comfortable doing such - either with previous experience or the willingness to learn.