Role overview

Qualifications

High School Diploma or GED
Data Entry experience
Letter writing skills
Microsoft Suite

Responsibilities

Maintains a caseload and monitors compliance of appeal decision time frames
Reviews clinical and medical records for completeness and determines appropriate action
Enters data related to appeals and case reviews into a database
Responds to inquiries regarding the status, process, and outcome of appeals

Key facts

Remote from: Anywhere
Fixed term
Conference Coordinator
English

Hard skills

Data Entry Software Suite

Other skills

Writing
Customer Service
Social Skills
Detail Oriented
Organizational Skills

About the company

Saviance Technologies Pvt. Ltd.

Saviance Technologies is a US Healthcare IT Service provider focusing on Patient Engagement with Innovative Products and Solutions like Patient Intake Tablet, iHealthConnect Wellness Portal, Mobile Applications, Actionable Analytics and ICD-10 Testing Services. Incorporated in 1999 in New Jersey, with over 15 years of excellent industry track record, Saviance offers services & solutions that enable enterprises to achieve critical objectives. Saviance is a Gold Category Corporate Member with Healthcare Information Management Systems Society (HIMSS), member of mHealth Alliance and Corporate member of NJ-HITEC. We are awarded by INC. 5000 as one of the fastest growing privately held companies in North America. Saviance is also ranked among the Fast 50 Asian American Businesses in the United States by USPAACC (US Pan Asian American Chamber of Commerce) and selected as a 2014 "Top Business" recipient byDiversityBusiness.com. A certified Minority Business Enterprise recognized by NMSDC, Saviance is also partner with leading global brands such as Microsoft, Amazon Web Services, Apple, Samsung and Red Hat.

Company details

Company typeSME

Company size51 - 200

Links

Website LinkedIn See all jobs

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Job description

JOB DESCRIPTION: Maintains a caseload and monitors day to day compliance of appeal decision time frames. Reviews clinical and medical records for completeness and determines administrative or clinical appeal. Assigns reviews to physician advisers and medical directors for those requiring medical necessity reviews. Enters all data related to appeals and case reviews into a database. Prepares and presents information on appeals to panels second-level multi-disciplinary committee. Participates in data gathering and analysis of reports regarding appeal activity as well as preparing for appeals audits, provides new employee training, monitors QI (Quality Improvement) activities of appeals department, and assists in the development of depart flows and implementations. Coordinates and distributes first, second and third level appeal request assignments. Consults with managers on problem cases and interfaces with case managers, clinical supervisors, account managers and other personnel in resolving denial and appeal questions. Responds to member, provider, and client telephone inquiries regarding status, process and outcome of appeals. Organizes volume of work and work-flow so that performance standards and proper procedures for appeals resolution according to client requirements and state and federal regulations are addressed. RESPONSIBILITIES: Experience in customer interactions and detailed review of health related materials. Strong interpersonal skills and attention to detail. Ability to organize work and seek help on tasks where needed. Strong writing and proofing skills required ensuring documents meet standards and are accurate. WORK EXPERIENCE: Customer Service EDUCATION: High School Diploma or GED (Required), Associates (Preferred)REQUIRED SKILLS:Top 3 Must-Haves (Hard Skills)
Data Entry experience
Letter writing skills
Microsoft Suite
Case management experience  Nice-To-Haves (Hard Skills)
Typing 50 WPM
Customer service
Healthcare experienceDegree Requirements   High school diploma or GED