DESCRIPTION/RESPONSIBILITIES:
Provide thorough analysis and investigation of authorization requests for specialized medical/surgical/outpatient procedures in an expeditious and accurate manner ensuring provider, hospital/facility, Primary Care Group (PCG), and member quality customer service. Provide information and assistance pertaining to the Medical Management program to providers, hospitals, PCGs and members.
* Assess and investigate requests for medical service authorization and authorize select services that do not require clinical judgment. Collect and record appropriate data in order to issue authorization and route request for services that require medical review to appropriate team member(s). .
* Facilitate communication with providers regarding status on authorizations and referrals. Identify relevant issues and route to appropriate department for action and resolution.
* Perform departmental functions such as: data preparation/presentation, interaction with internal and external sources to resolve inquires, assist with on-the-job training of new employees as requested, educate and direct providers on medical management policy, procedures, plan benefits and co-pays for all products.
* Promote and engage in positive and constructive daily team interactions.
* Perform other duties as assigned.
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, , national origin, orientation, age, gender identity, protected veteran status or status as an individual with a disability.
