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Review Assistant in Harrisburg, PA at KEPRO

Date Posted: 11/11/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    11/11/2018

Job Description

JOB TITLE:Review Assistant

REPORTS TO:Supervisor, Review Operations

DEPARTMENT:Operations

FLSA STATUS:( ) Exempt(X) Nonexempt

Summary Description

Prepares prior authorization cases for clinical review in order to streamline the review process. Maintains working knowledge of internal policies, procedures and services (both departmental and operational.) Ensures productivity and quality standards are met for required contract deliverables. Prepares all related documents, mailings and reports to meet requirements for eligibility, services and hearings.

Accountabilities

•Reviews patient records and compares against submission requirements to determine if all required information is present for the case. Identifies cases where additional non-clinical information is needed.
•Process and document case discharges.
•Accurate and timely submission of all administrative related documents to appropriate parties.
•Foster positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building in order to facilitate the review process.
•Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for case preparation.
•Maintains medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, adherence to HIPAA polices.
•Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following KEPRO’s policies, procedures and guidelines
•Cross-trains to perform duties of other contracts within the KEPRO network to provide a flexible workforce to meet client/consumer needs.

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•Associate’s Degree and/or equivalent work experiences related to medical, behavioral, or social/support settings.
•Bachelor’s Degree 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.
•Medical terminology and/or claims experience helpful.
•Working knowledge of software with healthcare or insurance application.
•Ability to work in a team environment.
•Ability to interpret complex documentation.
•Ability to organize and present case information clearly and accurately.
•Ability to work in a fast paced environment.
•Excellent verbal and written communication skills essential.
•Computer skills required with MS Word and Outlook and proprietary software.
•Strong critical thinking skills necessary.
•Flexibility and good organizational skills needed.

?Experience
•1-2 years of experience in administrative or records management.
•QI/Utilization review 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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