Description & Requirements
Essential Duties and Responsibilities:
- Maintain updated knowledge of project and corporate policies and procedures as referenced in the employee manual and other desk procedures for the position
- Function as a Subject Matter Expert in one or more process areas.
- Analyze data submitted for Independent Medical Review.
- Collect and analyze incoming data and reports from treatment providers, facilities, participants, labs and health plans to input necessary information into the system.
- Respond to incoming calls from clients, health plans, providers and enrollees regarding case status, questions about the program, and the appeals process.
- Maintain updated knowledge of project and corporate policies and procedures as referenced in the employee manual and other desk procedures for the position.
- Create arbitration cases in the system.
- Send requests for information to providers and health plans.
- Close arbitration cases in the system.
- Analyze data received from providers and health plans.
- Collect and analyze incoming data and reports from treatment providers, facilities, participants, laboratories and health plans to input necessary information into the system.
- Respond to incoming emails from clients, health plans, providers and enrollees regarding case status, questions about the Program, and the appeals process.
- Associate degree with 2+ years' experience.
- Experience in lieu of an Associate degree (HS Diploma or GED and 4+ years of experience) also considered.
- Strong organizational and multitasking abilities
- Excellent written and verbal communication skills
- Ability to work across multiple platforms
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint)
- Ability to successfully work in a fast-paced, deadline-driven environment
- Experience with Salesforce platform highly preferred
- Attention to detail and accuracy
- Ability to work independently as a part of a team
- Familiarity with insurance documentation, explanation of benefits, and/or claim forms highly preferred
- Knowledge of CPT codes preferred
- Ability to commit to a training schedule of 8am - 5:30pm EST Monday - Friday preferred
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US