Medical Management Clerk
Location: Kansas City
Posted on: April 9, 2021
Description:Provides information management services to the
Medical Management Department by researching and reviewing claims;
resolving customer service problems; and triaging and indexing all
medical records. Also assists with the substantive work of the
Medical Management department, including making determinations on
prior authorization issues not requiring clinical review.
- Researches, reviews and resolves claims and benefit questions
with Customer Service and other Operations areas.
- Regularly converses by phone with members and providers, either
directly or as transferred by customer service
- Receives pre-service review requests telephonically in a call
center environment for inpatient, outpatient or DME requests.
- Documents in a computerized tracking system.
- Receives faxed information via document imaging system for
inpatient admissions, outpatient services, DME, and post service
medical review. Responsible for indexing, triaging and data entry
- Reviews requests using a defined, approved script.
- Determines appropriateness of request, or, as necessary, refers
to clinical staff for review and certification of medical
- Generates letters of acceptance in FACETS to members and
providers or makes non-clinical contract denial decisions (clinical
denial decisions are made by a Medical Director).
- Contacts providers with determinations and if appropriate
provides appeals information and generates letters.
- Performs all duties in a manner consistent with the company's
Code of Conduct and policies and procedures and other related
duties as assigned to meet departmental and company
- Other duties as assignedSkills:Medical claim, Health care,
Clerical, Microsoft office, Claim, Data entry, Customer service,
medical records software, triage, prior authorization, benefit
verification, benefit plan, indexingTop Skills Details:
- Associate's degree from a college or university in business
administration, health care management, or other relevant academic
field OR three (3) years of experience in positions providing
intimate familiarity with medical terms; OR any combination of
education and experience providing the types and levels of
knowledge, skills, and abilities required by the job.
- Experience researching, summarizing, and communicating detailed
information and analysis
- Ability to read, analyze and interpret general business
periodicals, professional journals, technical procedures, or
- Ability to write reports, business correspondence, and
- Ability to effectively present information in one-on-one and
small group situations to customers, clients, groups of managers,
and other employees of the organization.
- Ability to define problems, collect data, establish facts and
draw valid conclusions.Additional Skills & Qualifications:
- Advanced keyboarding skills.
- Intermediate knowledge of and ability to use Microsoft Office
- Other specialized knowledge and skills preferred include HIPAA
requirements; UM denial/appeals specifications; NCQA, URAC, and
state and federal UM requirements.Experience Level:Entry Level
About Aerotek:We know that a company's success starts with its
employees. We also know that an individual's success starts with
the right career opportunity. As a Best of Staffing Client and
Talent leader, Aerotek's people-focused approach yields competitive
advantage for our clients and rewarding careers for our contract
employees. Since 1983, Aerotek has grown to become a leader in
recruiting and staffing services. With more than 250 non-franchised
offices, Aerotek's 8,000 internal employees serve more than 300,000
contract employees and 18,000 clients every year. Aerotek is an
Allegis Group company, the global leader in talent solutions. Learn
more at Aerotek.com.The company is an equal opportunity employer
and will consider all applications without regards to race, sex,
age, color, religion, national origin, veteran status, disability,
sexual orientation, gender identity, genetic information or any
characteristic protected by law.
Keywords: Aerotek, Kansas City , Medical Management Clerk, Healthcare , Kansas City, Kansas
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