PHRN

Responsibilities:

Provide support to the clinical team and client team.
Determine customer eligibility by reviewing contractual language and medical documentation.
Assess medical appropriateness of claims submitted, and adjust claims as needed.
Pay all covered claims accurately and timely.
Manage both new claims and open claims equally and maintains decision turnaround times.
Required Skills:
-Active license
-At least 6 months Hospital experience
-1 year prior authorization experience – negotiable: Healthcare experience
-Handling payer side/ provider side/ handling scheduling or any inbound process
-Good typing skills.
-Scope of work inbound or outbound calls or pre-reg- patients that are scheduled outpatient imaging, update insurance, provide prep/ patient instructions.

Additional Notes:
This position will be working with world’s largest medical coding staff.

Working Set-up: Onsite.
Mondays to Fridays.