Health Services Assistant
The Care Coordination team is hiring for a Health Services Assistant!
As a Health Services Assistant, you will be responsible for supporting Health Services Coordination functions including, but not limited to, medical records coordination, technical retrospective claims review, referral/auth. entry, research which may include but not limited to claims, eligibility, benefits, provider contracts, coordination of benefits, provider education, data entry report generation, act as liaison to and/or assists PHS clinical leaders.
Type of Opportunity: Full Time FTE: 1.000000 Exempt: No Work Schedule: Mon-Fri 8:00am-4:30pm with rotation of weekends every three months.
Qualifications
- High School Diploma GED required. Associates Degree or completion of a medical vocational program preferred. One to three years' experience in a medical or health insurance position
Education Essential:
- High School Diploma or GED
Responsibilities
- Prior Authorization may process emergent/elective and transitional prior authorization requests according to established evidenced based criteria. Screens prior authorization requests not meeting guidelines and requests/gathers/forwards additional information.
- May conduct utilization review by monitoring daily prior authorization requests and documenting timely updates for service requests. Completes Administrative Denials and submits Medical Director Reviews as directed.
- Correspondence with Provider/Member Notifies members and providers including but not limited to approvals, provider notification of service requests and out of network approvals
- Coordination of Benefits by monitoring benefit limitations for all members. Identifies members for case management or needed follow up regarding subrogation or coordination of benefits. Refers to appropriate departments as needed. Provides claims follow up as indicated.
- Documents in multiple computer applications timely and according to unit policy and regulations. Documents appropriate codes and claims payment information to ensure accurate claims payment. Data entry to ensure accurate records notifications/referrals. Submits Patient referrals for complaints and compliments.
- Liaison with providers and facilities telephonically, include problem solving regarding member needs, Requests clinical updates.
- May respond to incoming calls routed through skill-based technology to meet quality standards and performance measurements. May conduct outbound calls as required and meet established quality/quantity guidelines supporting initiatives and/or programs.
Benefits
We offer more than the standard benefits!
Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!
About Presbyterian Healthcare Services
Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.