•Process referrals in accordance to Concur Policy /Procedures and health plan requirements. (This includes checking eligibility, verifying benefits, verifying medical necessity, and knowledge of referral networks. Contact health plans for referrals/ pre-certifications that require health plan approval.)•Applies MCG guidelines, Medical Group Guidelines and CMS coverage determinations to referral requests as appropriate. Ensures referrals are approved within the network as medically appropriate.•Reviews referrals not meeting medical group criteria with the Medical Directors as needed.•Initiates the processing of denials in accordance with health plan and regulatory requirements under the direction of the Manager, Care Management and Medical Director.•Interacts in a professional manner with providers, patients, physicians and staff by demonstrating respect not limited to communications via telephone, E-mail, My Chart or Staff Message.•Resource for training Utilization Management staff on proper work procedures and policies. (This includes, training new employees and cross training existing employees.)•Act as a resource for the Clinical Services Department, physicians, providers, patients and work colleagues.

• Performs Insurance Verification of benefit coverage on all of patient's insurance plans for each service being provided. • Obtains and documents in the system all information related to coinsurance, copay, deductibles, authorization requirements, etc. • Creates documentation required to service the patient per policy and payer guidelines. • Determines estimated patient financial responsibility using insurance verification information and payer contracts and/or self-pay guidelines. • Obtains initial authorization prior to admitting the patient for all services for any insurance plan that has authorization requirements. • Obtains reauthorization as necessary, reviews physician orders from pharmacy to determine if authorization is required on changes / additions to therapy for patients that are already on service

• Process diverse, time-sensitive on boarding requests – new service, site adds, upgrades, and service changes – for newly rolled out telecommunication product.• Work with internal on boarding team to provide best possible customer experience and ensure successful communication lines between field and account teams.• Document and handle large contracts with detailed order forms using Microsoft Excel and Google Forms.• Compare customer configuration data in live systems with contractual documents and Customer Service Plans to ensure they are in sync.• Coordinate with North American Service Support organization to approve customer contracts to effect revenue realization as scheduled.

• Receive incoming requests for information and respond to requests by opening mail, assisting walk-ins and telephone inquiries, and retrieving facsimile inquiries in a timely manner. • Validate requests and authorizations for release of medical information according to established procedures and HIPAA guidelines. • Complete release of information requests including retrieving patient’s medical charts and returning charts, copying/scanning medical records accurately and correctly, according to requests, established procedures, and established standards of quality and productivity; and electronically transmits medical record to processing operations. • Perform quality checks on all work to assure accuracy of the release, confidentiality, and proper invoicing.• Provide excellent customer service by being attentive, respectful and professional at all times; insures understanding of customer request and follows-through as promised; being proactive in identifying and addressing member concerns, or problems.• Demonstrate helpful and effective telephone etiquette and customer service skills by providing appropriate information to callers.• Adapt to change and respond to difficult and challenging situations in a professional manner. • Work with minimum supervision, organize workload and prioritize work tasks to meet production goals.

• Ensure superior client care and maximum productivity of the veterinary medical team. • Maximize the number of pets seen by the hospital team through a productive and efficiently run hospital to support the needs of our wellness plan clients. • Provide professional, efficient and exceptional service at all times. • Educate clients about Optimum Wellness Plans, preventative care, pet health needs and hospital services • Assist incoming clients by completing the required documentation, entering all pet information and history in the computer, utilizing proper collars and tags for identification, and ensuring prompt service. • Assist outgoing clients by providing all necessary instructions, information and invoices, dispensing prescription items per the veterinarian's instructions, and scheduling future appointments. • Manage the finances by maintaining accurate balances and utilizing proper opening and closing procedures. • Conduct administrative functions as necessary.

Customer ServiceSupport customers via phone, email, ticketing, and chat.Reach out to customers via phone to proactively identify and solve problems.Document and train customers on common issue resolution.Utilize ticketing system for issue escalations and product requests.

*Customer Service*Support customers via phone, email, ticketing, and chat.*Reach out to customers via phone to proactively identify and solve problems.*Document and train customers on common issue resolution.*Utilize ticketing system for issue escalations and product request.