Review Assistant II

This position is responsible for inbound and outbound communication in support of case review activities including collection and confirmation of data integrity in support of clinical review services.
This individual will be required to be in-office two days a week.

Essential Functions

• Interprets review guidelines to facilitate forward movement of the case review process including requests for clinical information, treatment plans, discharge dates and communicating the authorization for requested services. Coordinates, distributes and tracks highly confidential medical information from multiple sources (fax, web, and phone). Interprets and adheres to URAC standards for assigned programs as well as federal and state requirements.
• Ensures quality customer service by responding to phone inquiries from members, physicians, and providers. Prioritizes workload to meet program or regulatory time frames.
• Provides verbal and written communications of review decisions to include administrative denials. Completes service/treatment screens for accurate transmission of outcome decision.
• Provides general office support and performs miscellaneous duties as assigned.

Requirements

• High school diploma or equivalent; 2 years of experience working in a customer service or healthcare environment
• Demonstrated ability working with confidential information and in a deadline driven environment
• Excellent verbal and written communication skills and intermediate PC skills.
• Positions working on specific contracts may require U.S. Citizenship.


• Experience in a health care environment preferred.
• Satisfactory completion of medical terminology course preferred.
• Intermediate PC functions preferred.

Who We Are: Telligen is one of the most respected population health management organizations in the country.  We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Health has changed a lot through our 50-year history, but what has remained constant is that we care deeply about who we serve and what we do. Our success is built on our ability to adapt, respond to client needs, and offer innovative solutions. Our business is our people and we’re looking for talented individuals who not only believe in our mission but who are ready to take ownership and make a difference in the lives of people, in the world of health. Learn more about who we are and what we do at www.telligen.com/about-us Are you Ready? We’re on a mission to transform lives and economies by improving health and getting there means following through on our values of Ownership, Community, Ingenuity & Integrity.  Ownership: As a 100% employee-owned company, our employee-owners drive our business, our solutions, and share in our success. When employee-owners grow and thrive, we all win.Community: Putting others first and being a good corporate partner wherever we work, and play makes us who we are. We Show Up. For our clients, for our communities, and for each other.Ingenuity: We’re a team of passionate professionals driven by hard work and big ideas. We understand that high-value breakthroughs come from taking calculated risks. If it will benefit our clients and advance our mission, we’re all ears. We celebrate free-thinking and challenge the status quo, so brainstorm away! Integrity: Smiling faces (virtual or in-person) are the norm around here. We enjoy a friendly work environment where everyone is dedicated to mutual trust, respect, and excellence.  Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed.
While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate.As part of our commitment to health and safety, some roles may require additional health protocols (i.e. personal protective equipment or vaccination).Telligen and our affiliates are Affirmative Action, Equal Opportunity Employers, and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. Telligen does not accept 3rd party solicitations from outside staffing firms.