Responsibilities
- Notify nursing staff of all requests and hospitalizations that need further review
- Make approval decisions based on established protocols and guidelines
- Forward medical questions or potential denial decisions to nursing staff for additional review
- Assist in the medical review process for referrals, prior authorizations, inpatient reviews, and claims reviews by gathering supporting information and documentation to help determine necessity, benefits, and reconsiderations
- Provide telephone customer service to members, providers, and other Health System or Quartz staff regarding authorization requests, hospitalizations, and claim questions
Requirements
- High school diploma or equivalent
- At least one year of experience in a healthcare environment, such as claims processing, medical billing or insurance claims, or related work
- Experience with computer applications like MS Office and/or Epic
- Strong attention to detail and excellent organizational skills
- Excellent verbal and written communication skills, including phone skills
Nice to Have
- Prior data entry and word processing experience
- Knowledge of medical terminology; previous experience in a medical office or medical field
- General knowledge of NCQA requirements
Benefits
- Full-time, remote work environment available
- Work schedule is an 8-hour shift between 8:00am and 5:00pm, Monday through Friday
- Starting pay range: $21 - $26.45 per hour
- Hardware and equipment provided by the company
- Competitive compensation
- Excellent benefit package
- Professional culture built on the foundations of Respect, Responsibility, and Relationships
Compensation
$21 - $26.45 per hour
Work Arrangement
Hybrid — Madison, WI, Onalaska, WI
Other
- Candidates must have access to high-speed Internet to successfully work from home
- All employment offers are contingent upon successful completion of a pre-employment criminal background check
