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Medical Management Clerk

Company: Aerotek
Location: Kansas City
Posted on: April 9, 2021

Job Description:

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 representatives.
  • 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 into Facets.
  • Reviews requests using a defined, approved script.
  • Determines appropriateness of request, or, as necessary, refers to clinical staff for review and certification of medical appropriateness.
  • 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 objectives.
  • 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 governmental regulations.
    • Ability to write reports, business correspondence, and procedure manuals.
    • 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 applications preferred.
      • 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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