Remote Care Review Processor

JOB DESCRIPTION Retuurn Solutions works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

• Provides telephone, clerical, and data entry support for the Care Review team.
• Provides computer entries of authorization request/provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes.
• Responds to requests for authorization of services submitted via phone, fax, and mail according to Retuurn Solutions operational time frames.
• Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.

HS Diploma or GED

1-3 years experience in an administrative support role in healthcare.

Associate degree

3+ years experience in an administrative support role in healthcare, Medical Assistant preferred.

Retuurn Solutions offers a competitive benefits and compensation package. Retuurn Solutions is an Equal Opportunity Employer (EOE) M/F/D/V.