Client Services Specialist 59270
Medical Recruitment Strategies Kenner, LA
- Expired: over a month ago. Applications are no longer accepted.
2-4 years of medical assistant experience
Experience with prior authorizations and insurance claims
MUST be available 8a - 5p Mon - Fri; overtime is possible as needed
Will be working remote; must have private quiet place to work and fast reliable Internet
Must be in commuting distance to Kenner, LA - may be asked to go in for the first day for equipment pick up and set up
**Non safety sensitive - no drug screens required**
- Supports comprehensive coordination of medical services including intake, screening and referrals to Aetna Medical Services Programs.
- Promotes/supports quality effectiveness of Healthcare Services.
- Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
- Utilizes eTUMS and other Aetna system to build, research and enter member information.
- Screens requests for appropriate referral to medical services staff.
- Approve services that do not require a medical review in accordance with the benefit
- Performs non-medical research including eligibility verification, COB, and benefits verification.
- Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
- Promotes communication, both internally and externally to enhance effectiveness of
medical management services (e.g., claim administrators, Plan Sponsors, and third party payers as well as member, family, and health care team members respectively).
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality Communicate with Aetna Case Managers, when processing transactions for members active in this Program.
- Supports the administration of the precertification process in compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures.
- Places outbound calls to providers under the direction of Medical Management Nurses to obtain clinical information for approval of medical authorizations.
- Uses Aetna Systems such as QNXT, ProFAX, ProPAT, and Milliman Criteria.
- Communicates with Aetna Nurses and Medical Directors, when processing transactions for members active in this Program.
- Sedentary work involving significant periods of sitting, talking, hearing
- Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor.
Medical Recruitment Strategies
Medical Recruitment Strategies (MRS) is a recruiting firm that specializes in the placement of professionals in pharmacies, hospitals, healthcare organizations and life sciences companies. We offer contract and direct hire services and work all over the U.S. Over the last 16 years, we have become a premier provider of talent.
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