the smart solution for Cheyenne jobs

Medical Policy Specialist

Company: Conduent
Location: Cheyenne
Posted on: October 8, 2018

Job Description:

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

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Healthcare Jobs

family medicine /internal medicine Physician MD/DO Greenwood Village, Colorado (Denver)
Description: Seeking a Part Time Physician MD/DO for private practice medical office in Greenwood Village, Colorado Denver Schedule: 1 day
Company: HRC
Location: Aurora
Posted on: 10/18/2018

Respiratory Therapist
Description: Facility: Medical Center of the Rockies Department: MCR RT Schedule: Full-time Shift: 3rd Shift - Nights Scheduled Days Hours: 72 hrs/pp, Nights and hours vary, 6:30pm-7:00am Requisition number: 82649 (more...)
Company: UCHealth
Location: Loveland
Posted on: 10/18/2018

Non medical in home caregiver
Description: Comfort Keeper--a national franchise is looking for COMPASSIONATE, CARING, SELF MOTIVATED caregivers,
Company: Comfort Keepers
Location: Denver
Posted on: 10/18/2018

RELOCATION OPPORTUNITY: RN - Surgical: Winston-Salem, NC
Description: OverviewNovant Health is seeking a Surgical Registered Nurse to serve as a leader of the healthcare team by establishing an authentic personalized relationship with the patient and their support system. (more...)
Company: Novant Health
Location: Cheyenne
Posted on: 10/18/2018

Excellent Child/ Adolescent Psychiatry Position Available in Denver, CO
Description: Child/ Adolescent Psychiatry Chief Medical Officer needed for the Denver Colorado area. This is a leadership role for qualified
Company: MD Doc Jobs
Location: Aurora
Posted on: 10/18/2018

Become Your Own Health Care Boss
Description: We are interviewing Benefit Consultants to work from home. Our Company has been in business for 26 years. We strive to help families save money on their medical and dental needs. We are not an insurance (more...)
Company: AmeriPlan
Location: Broomfield
Posted on: 10/18/2018

Medical Coder Specialties
Description: Coding Denials, ER, OBGYN, Surgical, E/M, Neurology, Neurosurgery, Oncology, Hematology, Orthopedic Pathology Multi-specialties We are hiring coders with at least three years experience in various (more...)
Company: Mommy Jobs Online
Location: Boulder
Posted on: 10/18/2018

Registered Nurse (RN) - Per Diem - Telemetry (Tele/PCU)
Description: Registered Nurse RN - Per Diem - Telemetry Tele/PCU Job Description Entrust Your Career to HealthTrust Unit: Telemetry Tele/PCU As HealthTrust Workforce Solutions, we focus on a healthcare facility's (more...)
Company: HealthTrust Workforce Solutions
Location: Denver
Posted on: 10/18/2018

Hiring CNA's - 12 Hour Shifts - Start ASAP
Description: We are looking for LONG-TERM, exceptional caregivers that thrive in the team environment. The client we are hiring for may require overnights and weekends. The ideal candidates will be flexible, can support (more...)
Company: Homewatch CareGivers
Location: Commerce City
Posted on: 10/18/2018

Caregivers, Personal Assistants, CNA's
Description: HOMEWELL - AGE IN PLACE WITH DIGNITY AND GRACE TMHomeWell Senior Care is a rapidly growying northern Colorado
Company: HomeWell Senior Care
Location: Loveland
Posted on: 10/18/2018

Log In or Create An Account

Get the latest Wyoming jobs by following @recnetWY on Twitter!

Cheyenne RSS job feeds