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Manages incoming calls or incoming claims work.
Determines contract & benefit eligibilit; Provides authorization, post service request.
Refers cases requiring clinical Review to a nurse reviewer.
Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
Responds to telephone and written inquiries from clients, provides and in-house departments.
Conducts clinical screening proces.
Authorizes initial set of sessions to providers.
Checks benefits for facility based treatment.
Developes and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Answered an average of [50+] calls per day by addressing customer inquiries, solving problems and providing new product information.
Assist valued patient's with home health and durable medical equipment.
Provide authorization status to provider's assisting Blue Cross Blue Sheild patients.
Provide excellent customer service using "Ulysses" call stradegy
|PC knowledge, Mac knowledge, QuickBooks Pro, QuickBooks POS, Microsoft RMS, Microsoft Office, Microsoft Access, Microsoft Publisher, SweetQ, AMISYS, Bloomberg and Quotron|
Positive credientialing specialist with demonstrated capabilities in provider credentialing. Committed to excellent work, learning and collaboration.