+ Performs clerical functions to support the care management and social work teams. + Fax clinical reviews to review agency and captures in designated system (EMR, CM software, etc + Develop and maintain filing system as needed. Reviews, sorts and files a variety of materials. + Develops and maintains the following: List of review agencies, contacts, including phone and fax numbers and updates or verifies for accuracy on a regular basis. + Determine correct person, phone, and fax numbers to give reviews to new patients. + Screens and directs incoming telephone calls for department with courtesy, respect and professionalism. Distributes daily mail (internal and external) as well as emailed requests to respective CM for clinical information received from payers. + Pulls daily reports and communicates per Case Manager or leader in Department. + IM letters distribution + Compiles the data and reports for UR Committee to present to the committee + Creates Excel Graphs & PowerPoint slides & presents findings to the UR Committee monthly + Maintain daily insurance logs & cert status in Epic + Medicaid Cert Process + Track 100% of commercial payer account authorization outcomes + Compiles Monthly Commercial Denials, Analyzes outcomes & follows up with payor via phone or Insurance Websites + Provides documentation & follow through on cases referred for outside appeal. + Enters Insurance information & Payor outcomes into Excel, EPIC + Completes Medical Record Review on Medicaid Workque & completes Medicaid Certification review forms + Coordinate Peer to Peer + Liaison with HIM & Pre-Cert + Follow denials process from initiation to closure & capture outcome + Provide documentation and follow through on cases referred for outside appeal + Completes CM Review Needed Workque & discusses missing documentation with PA’s + Completes denials on PA Review forms & discusses cases with PA’s + Contacts Payors to clarify & review denied days & outstanding last covered days if Payor Websites are not updated or accurate Required: + High School Diploma Preferred: + Prefer Associates or Bachelors degree in related field + Training or experience in health care field, familiar with health care terminology. + Training or experience with basic secretarial functions/equipment (PC, fax, telephone) + Effective verbal and written communication skills. + Broad knowledge of computer software including word processing, spreadsheets and presentation applications; keyboarding skill level at 45wpm. + Preferred for positions in medical/clinical areas: basic medical and scientific terminology. + Bilingual preferred.