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Lead Review Assistant - HWDRG in Tampa, FL at KEPRO

Date Posted: 12/11/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Tampa, FL
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    12/11/2018

Job Description

•         Assists Supervisor with monitoring and directing of daily workload of Review Support area, ensuring performance standards are met. Makes adjustments to workload as needed

•         Monitors helpline calls to observe employee demeanor, technical accuracy, and conformity to company policies. 

•         Resolves escalated issues and addresses customer complaints.

•         Trains all new staff on appeals intake, helpline and fax box functions as needed.

•         Identifies continuous learning needs and develops and implements plans to address identified learning needs.

•         Responsible for requesting, monitoring and all aspects of the Physician Acknowledgement Statement Process.

•         Answers the Beneficiary helpline and determines how best to assist helpline caller either by a service offered by KEPRO or by referring to an external agency.

•         Supports supervisor and management team with various projects and assignments.

•         Provide intake for appeals received by KEPRO by working with providers to get medical records and validate notices and components of the medical records.

•         Enter all relevant data into appropriate systems; maintains timely data entry throughout entire case review.

•         Subject Matter Expert for all appeal types and their various processes.

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