Professional interaction with Nurses, Insurance Adjusters and other medical professionals Intake / Data Entry of UR referrals and case assignment Evaluate faxes received by looking for identifying information and through thorough research in the Data system; link files to open requests by the clinicians that is instrumental in their completion of the review process Scan, upload and label case documents into appropriate case files Process administrative tasks for the clinicians such as handling of inbound faxes under the Managed Care Folder and ensure proper transmittal of documents to the appropriate queue Collection of medical files and documents to be scanned, indexed and uploaded to web base Utilization Review case management application Sort EMR and documents Enable the clinician to plunge in to the review process of the document once queued by the Intake team Properly determine the correct path for the services requested from the received fax and be able to move to the appropriate clinicians to review the case i.e. urgent care/non-urgent care all have different timetable/TAT that will impact NCQA Other tasks assigned

 

Skills and Qualifications

Any college education At least 6 months of Healthcare BPO work experience; Related UM/UR intake work an advantage Ability to multitask across multiple applications Strong analytical skills with excellent attention to detail Great team player with excellent interpersonal skills