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Utilization Management Rep II - Tennessee - PS1098 in Memphis, TN at Anthem, Inc.

Date Posted: 3/13/2018

Job Snapshot

  • Employee Type:
  • Location:
    Memphis, TN
  • Job Type:
  • Experience:
    At least 2 year(s)
  • Date Posted:

Job Description

Responsible for managing incoming calls, including triage, opening of cases and authorizing sessions. Primary duties may include, but are not limited to: Managing incoming calls or incoming post services claims work. Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests. Obtains intake (demographic) information from caller. Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given. Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization. Verifies benefits and/or eligibility information. May act as liaison between Medical Management and internal departments. Responds to telephone and written inquiries from clients, providers and in-house departments. Conducts clinical screening process. Requires HS diploma or equivalent; 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience, which would provide an equivalent background.


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