Medical Case Manager/Pre- Authorization Coordinator

Job Description

THIS IS NOT A REMOTE POSITION

Position Purpose:

Work with patients and insurance companies to obtain prior authorizations for specific medical procedures as prescribed by medical staff. Responsible for keeping accurate records and authorization paperwork for each patient and provide documentation for insurance providers. Must be comfortable with talking with patients and customers on the phone. This position involves mostly on-phone work, in a call-center type environment, as well as photocopying/scanning/printing duties as needed.

Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations.

Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list and coordinate Case management. Route to appropriate staff when needed.

Verify eligibility and benefits

Answer phone queues and process faxes within established standards

Data enters authorizations into the system.

Position Requirements:

Worker's Compensation Experience (preferred But Not Required)

Pre-Admission Experience

Patient Access Experience

Knowledge of CPT and ICD-10 coding.

Knowledge of EOB's

Team player

Reliable

Maintain strict confidentiality.

Work with spirit of teamwork and cooperation and with a commitment to constantly improving the work environment.

Education/Experience: High school diploma or equivalent. 3+ years of pre auth & customer service experience. Knowledge of medical terminology preferred.

Company Description

The Reny Company is a rapidly growing health care cost containment company, helping clients save money and better navigate our changing health care system. We specialize in medical bill review and negotiation services for workers compensation, non-subscribers, third party administrators, and maritime clients.

The Reny Company is a rapidly growing health care cost containment company, helping clients save money and better navigate our changing health care system. We specialize in medical bill review and negotiation services for workers compensation, non-subscribers, third party administrators, and maritime clients.