Utilization Review Specialist
Current-Front line of the pre-certification process-Ensures a high volume of pre-certification authorization requests and calls are processed accurately and timely. -Provides great customer service when addressing Members, Providers, in relation to the health plan- Knowledge of managed care and/or health care industry, familiar with medical terminology and experience with the authorization process of health care benefits.- Contact insurance companies and utilize web portals and websites for prior authorizations/pre-certifications, appeals, eligibility, remittance, and payment information.- Review and reconcile patient accounts, identifying and resolving billing discrepancies.