Description :Responsibilities:Supports customer service activities and initiatives for a number of products or clients including but not limited to the Case Management and Utilization Management departments.Job ResponsibilitiesScreen incoming calls and/or faxes or other digital format for UM and/or CM and direct calls/faxes/other digital requests to the appropriate area. Identify and refer cases appropriately to the Case Management and/or Transition of Care department.Receiving, investigating and resolving customer inquiries and claims. Maintain departmental goals. Perform projects, review and handle reports as assigned.Load complete organization determination/notification for services designed by internal policy. Clearly document and key data in to the appropriate system using departmental guidelines.Interact with membership, hospital and provider staff, advising of UM decision, status organization determinations, giving direction as necessary.Search for and key appropriate diagnosis and /or procedure code as part of the notification /prior authorization process.Must be able to pass required testing.Participation and attendance are mandatory.This position requires flexibility, due to rotations in schedules, and requires adherence to assigned schedules.Work overtime as requiredJob QualificationsEducationHigh School Diploma or equivalentExperience1 year - Customer service experience is requiredSkills\CertificationsProficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)Proficient oral and written communication skillsProficient interpersonal and organizational skillsExceptional time management skillsAbility to work independently under general supervision and collaboratively as part of a team in a fast paced environmentIndependent, Sound decision-making and problem-solving skillsIf current employee with the company, must meet minimum performance expectationsExtensive knowledge of all aspects of Utilization Management, Care Management, and Behavioral Health.Knowledge and understanding of Medical terminologySolid knowledge and understanding of provider reimbursement methodologies, ICD-9-CM, CPT, HCPCS and UB-92 coding, UHDDS coding guidelines, AHA Coding ClinicAbility to talk and type simultaneously in a clear and concise manner while interacting with customersComments/Special InstructionsAppeals and/or Grievance Preferred.Experience with Dual - SNP plans preferred.8:00 AM-5:00 PM.VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status
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