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Lead Review Assistant in Tampa, FL at KEPRO

Date Posted: 12/10/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Tampa, FL
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    12/10/2018

Job Description

Accountabilities

 

•         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.

 

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.


 

 

 

 Qualifications

§  Education (general level if required) or specific courses

•         High School diploma or equivalent required.

•         Medical terminology and/or transcription certification or coursework strongly preferred.

§  Knowledge, Skills, Abilities (KSA)

•         Knowledge of general review of records, claims or requests in a healthcare related field. 

•         Knowledge the organization of medical records, medical terminology, disease process.

•         Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; works well in group problem solving situations; maintains a calm demeanor in difficult situations.

•         Responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments.

•         Speaks clearly and persuasively in a variety of situations under varying circumstances; listens and obtains clarification.

•         Excellent interpersonal skills essential.  Flexibility to work with a diverse group of personnel of all levels with tact and diplomacy.

•         Advanced organizational skills required.

•         Ability to handle multiple priorities. 

•         Deadline oriented.

•         Knowledge of Microsoft software applications (Word, Excel, PowerPoint, Outlook). 

§  Experience

•         3-5 years of experience in administrative or records management.

•         Medical record handling experience helpful.

§  Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

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