Remote Care Review Processor

Easy Recruiter; Houston (TX); Remote; USD 36,000 - 48,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

Retuurn Solutions is seeking a Remote Care Review Processor to support the Care Review team with telephone, clerical, and data entry tasks. The role involves handling authorization inquiries, verifying eligibility and benefits, and coordinating with providers to obtain missing information.

Ideal candidates have 1–3 years of healthcare administrative experience, HS Diploma or GED, and preferably an Associate degree. Competitive benefits offered. EO, M/F/D/V.

Qualifications

• HS Diploma or GED required.
• Associate degree preferred.
• 1-3 years in healthcare administrative support.

Responsibilities

• Provides telephone, clerical, and data entry support for the Care Review team.
• Processes authorization requests and inquiries, including eligibility and benefits verification.
• Responds to authorization requests via phone, fax, and mail within operational timeframes.
• Contacts physician offices to request missing information as needed.

Education

HS Diploma or GED

Associate degree

Job description

About the job Remote Care Review Processor

JOB DESCRIPTION Retuurn Solutionsworks with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

• Provides telephone, clerical, and data entry support for the Care Review team.
• Provides computer entries of authorization request/provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes.
• Responds to requests for authorization of services submitted via phone, fax, and mail according to Retuurn Solutionsoperational timeframes.
• Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.

Job Qualifications

HS Diploma or GED

Required Experience

1-3 years experience in an administrative support role in healthcare.

Preferred Education

Associate degree

Preferred Experience

3+ years experience in an administrative support role in healthcare, Medical Assistant preferred.

Retuurn Solutionsoffers a competitive benefits and compensation package. Retuurn Solutions is an Equal Opportunity Employer (EOE) M/F/D/V.