Job Details

ID #21222605
State Missouri
City Jeffersoncity
Full-time
Salary USD TBD TBD
Source Anthem, Inc.
Showed 2021-10-16
Date 2021-10-16
Deadline 2021-12-14
Category Et cetera
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Referral Specialist I or II

Missouri, Jeffersoncity, 65101 Jeffersoncity USA

Vacancy expired!

Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.The Referral Specialist on the appeals team is responsible to assist in the day to day processing of member and provider appeals, provider courtesy reviews, and reconsiderations across solutions. Responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals for various AIM services.Responsibilities:Initiates and manages clinical referrals for pre-authorization.

Acts as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources.

Reviews referrals for completeness and follows up for additional information if necessary.

Assigns escalated referrals to staff as appropriate.

Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures.

Responds to inbound calls initiating exam requests following established processes, meets quality and production standards.

Contacts physician offices as needed to obtain demographic information or related data.

Enters referrals, documents communications and actions in system.

Other duties as assigned

Qualifications Requirements:High School diploma or GED

Experience working with MS Excel, MS Outlook, and MS PowerPoint

Must have an average typing speed of 45+ WPM

Must be able to work 9:30 AM to 6 PM PST / 11:30 AM to 8 PM CST

Preferred Qualifications:Experience in a high-volume, interactive customer service or call center environment

Experience working in a hospital, physician's office, or medical clinic environment

Medical coding and/or medical terminology experience

Experience in insurance pre-authorizations

Soft Skills:Solid typing skills and familiarity with computer systems

Able to navigate technology/multiple platforms and applications

Ability to communicate professionally, verbal and written, with nurses, physicians, leadership, and customers

Demonstrated ability to operate independently and as part of a team to follow directives

Prioritization, organizational, and critical thinking skills

Ability to multi-task

Commitment to quality and excellence

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positionsREQNUMBER: PS60898-Missouri

Vacancy expired!

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