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Review Assistant II chez Telligen

Telligen · West Des Moines, États-Unis d'Amérique · Hybrid

Microsoft Excel

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Description

This position is responsible for inbound and outbound communication in support of case review activities including collection and confirmation of data integrity in support of clinical review services.

Essential Functions

  • You will interpret review guidelines to facilitate forward movement of the case review process including requests for clinical information, treatment plans, discharge dates and communicating the authorization for requested services.
  • You will coordinate, distribute and track highly confidential medical information from multiple sources (fax, web, and phone).
  • You will interpret and adhere to URAC standards for assigned programs as well as federal and state requirements.
  • You will ensure quality customer service by responding to phone inquiries from members, physicians, and providers. Prioritize workload to meet program or regulatory time frames.
  • You will provide verbal and written communications of review decisions to include administrative denials.
  • You will complete service/treatment screens for accurate transmission of outcome decision.
  • You will provide general office support and perform miscellaneous duties as assigned.

    • Requirements

  • High school diploma or equivalent required
  • Minimum 2 years of experience working in a customer service or healthcare environment
  • Minimum 2 years of experience with data entry
  • Demonstrated ability to work with confidential information and maintain strict confidentiality
  • Proven ability to work effectively in a deadline-driven environment
  • Excellent written and verbal communication skills
  • Intermediate PC/computer skills
  • Ability to work independently with minimal supervision
  • Able to travel throughout the Des Moines metro area, reliable transportation required for local travel
  • Experience in a health care environment preferred
  • Experience in Iowa Medicaid preferred
  • Experience in working remotely preferred
  • Satisfactory completion of medical terminology course preferred

    • Additional Information

    Who We Are:
     
    Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise.

    Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions.

    Our business is our people and we’re seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health.

    Are you Ready?
     
    We’re on a mission to transform lives and economies by improving health.
     
    Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.
    Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.
    Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.
    Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence.
      
    Thank you for your interest in Telligen!
    Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed.

    While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate.
    Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants.
    Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.
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