Medical Policy Specialist
Posted on: October 8, 2018
Medical Policy Specialist
$12.00/hour, AM Shift
Conduent Business Services - Cheyenne, WY
Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.
We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.
Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at .
POSITION: Medical Policy SpecialistDESCRIPTION:The Medical Policy Specialist is responsible for completing the PA process according to contractual requirements, this includes but not limited to entering the PA data, communicating with the providers, making sure the PA goes to QA and then to scan. Process all authorizations of medical necessity requests. They must accurately and timely work the Edit locations assigned to Medical Policy. They are also responsible for updating the Procedure, Drug and Diagnosis file according to the contractual requirements. This position is also responsible for processing appeals related to medical policy. It also may require other duties as assigned by the Medical Policy Manager. MAJOR POSITION RESPONSIBILITIES:1. Screen PA for all documentation and enter it into the MMIS system within 2 business days.2. Communicates with providers if documentation received is incomplete or missing.3. Sends PA approval or denial letters to providers within 2 business days after review.4. Sends completed PA to QA and then to Scan.5. Screen and process all authorizations of medical necessity requests within 10 business days.6. Maintains a phone line for providers. Documents all calls.7. Receives and processes PDD requests from the state within 2 business days.8. Process appeals that are related to medical policy within 10 business days.9. Meet internal quality standards.10. Works edits accurately and timely.REQUIRED QUALIFICATIONS:1. Strong communication skills both written and oral.2. Ability to maintain confidentiality and security.3. Strong analytical, comprehension, and problem solving skills.4. Ability to work under pressure and with little supervision.5. Must be able to work overtime when required.6. Ability to follow oral and written instructions and directions.7. Personal computer experience using Windows and Microsoft programs8. Strong customer service skills.9. Must be detailed oriented. 10. Must have good organizational skills and decision-making ability.11. Must be able to work independently and as a team member.12. Excellent attendance required.PREFERRED QUALIFICATIONS:1. Knowledge related to medical and health care practices.2. Strong knowledge and skill with Microsoft Office programs.SENSITIVITY OF POSITION:Works with protected health information (PHI).
Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form .
Keywords: Conduent, Cheyenne , Medical Policy Specialist, Healthcare , Cheyenne, Wyoming
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