Manages incoming or outgoing telephone calls, emails, and / or faxes, including triage, opening of cases and data entry into client system.
Determines contract; verifies eligibility and benefits.
Adhere to federal and state regulatory and / or client plan requirements and established workflows.
Obtains information from claimant or other supporting systems, emails and / or from fax.
Manages claims, collection of non-clinical information needed for review from claimants and providers, utilizing scripts to screen basic and complex requests.
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Graduate of Bachelor’s Degree in Nursing
Holds active and unrestricted local (PH) Registered Nurse license
Must have at least 3 months experience as a Registered Nurse in a clinical setting
Experience in a front-office (voice) call center or BPO back-office environment is an advantage
Knowledge of ICD-9 and ICD-10 and CPT codes is an advantage
Equal Employment Opportunity Statement
All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.