Offer summary

Qualifications:

High school diploma or GED is required., 1-3 years of experience in managed care or medical management settings is required., Basic knowledge of medical records and familiarity with health insurance lines of business is required., Proficient in Microsoft Office applications and strong attention to detail is required..

Key responsabilities:

Prepare and review inbound faxes for accurate document classification.

Monitor failed fax transmissions and coordinate re-sending of documents.

Respond to clinician inquiries and retrieve requested clinical documents for case review.

Assist with various administrative tasks while meeting established objectives and key results.

Job description

Job Title - Medical Documents Admin
Job Duration - 6+ Months
Job Location - 100% Remote
Working Shift - Training Schedule - 8:30 AM - 5 PM CST / 40 hours per week Monday-Friday
Shift Schedule after training - 9 AM - 6 PM CST / 40 hours per week Monday-Friday

Job Summary

Provides support to the Utilization Management Team.
The coordinator will support administrative operations by ensuring the efficient intake, review and processing of documents.
The general administrative support given will contribute to the overall effectiveness of the department.

Collaboration Opportunities:

The Coordinator, UM Intake reports directly to the Manager, UM Intake.
In support of our daily operations this individual also works with our prior authorization and clinical review teams.
Opportunities to work collaboratively with other UM staff including our leadership team both clinical and non-clinical may also be available.

What You Will Be Doing:

Prepare inbound faxes for coordinator processing which includes reviewing content and label editing to ensure accurate document classification.
Review Service Level Agreement Grids to determine appropriate turnaround timeframes (TAT) based on health plan, product type, line of business, code and priority. Accurately calculate and document the TAT.
Monitor the failed fax dashboard to identify unsuccessful transmissions and coordinate the re-sending of correspondence via appropriate channels.
Oversee and respond to requests in a shared email inbox by reviewing clinician inquires, retrieving requested clinical documents and attaching them for timely case review.
Assist with additional administrative tasks as assigned, demonstrating flexibility, strong attention to detail, and the ability to adapt to evolving department needs.
Meet established UM Intake Objective and Key Results.

Qualifications Required and Preferred:

A high school diploma or GED. (Required)
1 – 3 years of experience in a population management or managed care/insurance or hospital medical management department setting. (Required)
Basic knowledge of medical records with the ability to locate and verify member details. (Required)
Familiarity with health insurance lines of business (Commercial, Medicare, Medicaid) to correctly identify and classify incoming documents based on plan type. (Required)
Working knowledge of medical coding system including CPT/HCPCS codes to differentiate between medical and pharmacy prior authorization requests. (Required)
Ability to adapt to fluctuating situations and perform work of a detailed nature, while avoiding errors. (Required)
Proficient using computer and Windows PC applications (Outlook, Word, Excel and OneNote), which includes strong keyboard and navigation skills. (Required)
Team oriented, demonstrates a strong work ethic and committed to productivity. (Required)
Demonstrated ability meeting established goals while balancing a workload and prioritizing assignments in a remote environment. (Preferred)
Knowledge, Skills and Abilities (KSAs):
Sharp attention to detail and demonstrates initiative to quickly identify and resolve variances and discrepancies.
Excellent verbal, written and interpersonal communication skills.
Ability to work quickly and accurately.
Capable of working independently with limited supervision.
Strong problem solver
Excellent computer literacy, proficiency in Microsoft Suite and Teams
Works well in a team environment.

Technology Requirements:

Candidates must have Cable or Fiber internet connection. Must be able to plug computer into router/modem with ethernet cord. NO WIFI CONNECTION AVAILABLE.
Please confirm candidate’s internet connection using the link below: highspeedinternet.com
When you open the link, you will enter their home zip code # and search for the carriers in their area. 4G, 5G, LTE or Satellite Internet service is not compatible with software at Evolent.

Training / Attendance Requirements:

There is no pre-approved time off for 1st 4 weeks of assignment, and overall attendance expectations will be reviewed Day 1.
Please screen for this and gain commitment as attendance is critical for duration of assignment!
Workers will be required to be on camera during training and team meetings.

Required profile