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Review Assistant in Charleston, WV at KEPRO

Date Posted: 2/18/2018

Job Snapshot

Job Description

KEPRO

JOB DESCRIPTION

JOB TITLE:            ReviewAssistant

REPORTS TO:      Supervisor,Review Operations

DEPARTMENT:  Operations

FLSA STATUS:     Nonexempt

Summary Description

Prepares prior authorization cases for clinical review inorder to streamline the review process. Maintains working knowledge of internalpolicies, procedures and services (both departmental and operational.) Ensuresproductivity and quality standards are met for required contract deliverables.Prepares all related documents, mailings and reports to meet requirements foreligibility, services and hearings.

 Accountabilities

  • Reviews patient records and compares againstsubmission requirements to determine if all required information is present forthe case. Identifies cases where additional non-clinical information is needed.
  • Process and document case discharges.
  • Accurate and timely submission of alladministrative related documents to appropriate parties.
  • Foster positive and professional relationshipsand act as liaison with internal and external customers to ensure effectiveworking relationships and team building in order to facilitate the reviewprocess.
  • Responsible for attending training and scheduledmeetings and for maintenance and use of current/updated information for casepreparation.
  • Maintains medical records confidentiality at alltimes through proper use of computer passwords, maintenance of secured files,adherence to HIPAA polices. 
  • Utilizes proper telephone etiquette andjudicious use of other verbal and written communications, following KEPRO’spolicies, procedures and guidelines
  • Cross-trains to perform duties of othercontracts within the KEPRO network to provide a flexible workforce to meetclient/consumer needs.

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

 Qualifications

  • Associate’s Degree and/or equivalent workexperiences related to medical, behavioral, or social/support settings.
  • Bachelor’s Degree preferred
  • Knowledge of general review of records, claimsor requests in a healthcare related field. 
  • Knowledge the organization of medical records,medical terminology, disease process.
  • Medical terminology and/or claims experiencehelpful.
  • Working knowledge of software with healthcare orinsurance application.
  • Ability to work in a team environment. 
  • Ability to interpret complex documentation.
  • Ability to organize and present case informationclearly and accurately.
  • Ability to work in a fast paced environment.
  • Excellent verbal and written communicationskills essential.
  • Computer skills required with MS Word andOutlook and proprietary software.
  • Strong critical thinking skills necessary.
  • Flexibility and good organizational skillsneeded. 

Experience        

  • 1-2 years of experience in administrative orrecords management.
  • QI/Utilization review experience helpful.

Mental and PhysicalRequirements        

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

Equal Opportunity Employer

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