GENERAL SUMMARY
Responsible for the accurate and efficient processing of Outpatient Treatment Records by performing benefit, network, and authorization review activities within a contracted vendor system. Work is performed within a team environment. Serves as subject matter expert for contracted vendor system.
ESSENTIAL RESPONSIBILITIES
- Processes Outpatient Treatment Records in electronic work queues by performing benefit, network, and authorization review activities within a contracted vendor system in accordance with company policies and procedures.
- Researches and interprets member and provider information by effectively using contracted vendor and MHNet systems containing information including, but not limited to, member eligibility, member benefits, authorizations, and provider networks.
- Enters all finalized authorization data into MHNet systems; verifies data for accuracy and completeness.
- Demonstrates a full understanding of all products in all regions. Refers questions to Supervisor or Case Manager as appropriate.
- Takes responsibility for completing assignments and bringing all outstanding issues to closure.
- Responsible for production and quality standards.
- Maintains complete and accurate system documentation of all customer interactions.
- Maintains documentation in member files according to standard policies and procedures.
- Maintains resource information at workstation including benefit designs, plan information, and practitioner directories.
- Demonstrates professionalism and presents a positive image of the company when interacting with members and providers.
- Demonstrates responsiveness and a sense of urgency when dealing with members and providers.
- Supports individual and team goals and initiatives; accepts ownership for individual results.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent.
- Previous keyboard/data entry experience required.
- Previous work experience in a computer-based office environment required.
- Demonstrated analytical and problem solving skills.
- Must be able to navigate within a computer/systems-dependent environment without assistance;experience in a windows-based computer environment preferred.
- Knowledge of basic medical terminology required.
- Effective verbal and written communication skills.
- Ability to absorb and apply new and changing information.
- Ability to remain calm and controlled in stressful, unexpected situations.
- Ability to tactfully work with confidential information.
- Ability to maintain regular and consistent attendance in accordance with company and departmental policies and procedures.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Administrative Support Workers
Primary Location: Austin, TX, US
Organization: 51000 - MHNet Specialty Services, LLC
Schedule: Full-time
Job Posting: 2013-01-31 00:00:00.0
Job ID: 1310359