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Remote Health Insurance Clinical Coordinator/ Pre Auth ID-1164
About the position
Wipro Limited is a leading technology services and consulting company focused on building innovative solutions that address clients' most complex digital transformation needs. We are seeking customer service/claims processors who combine excellent coordination and authorization skills with the ability to function effectively both as part of a team or on an individual basis. This is a remote/work from home (WFH), full-time direct hire position. Employees must be able to work from 8am-5pm CST M-F during our 6-week training program, which will be conducted virtually from your home. After training, this position is full-time (40 hours/week) with variable shifts to support our 24-hour operations. Must be able to work Saturdays.
Responsibilities
Managing authorizations / notifications and other service requests received via incoming phone calls, faxes and portal submission
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Providing excellent customer service, including the ability to handle escalated callers
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Determining authorization or notification requirements
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Preparing authorization cases for Medical Directors, Network Operations Nurses and Case Managers
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Providing administrative approvals (depends on line of business)
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Handling expedited authorizations, authorization updates and status checks
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Confirming member eligibility
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Outreaches to providers and/or Patient to complete authorization requests and prescriptions
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Maintaining knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
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Utilizing experience and judgement to plan, accomplish goals and effectively resolve each assigned task
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Performing all other related duties as assigned
Requirements
High School Diploma / GED (or higher)
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2+ years of combined or related experience in a healthcare, call center, and/or customer service setting using the telephone and computer as the primary instrument to perform job duties
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Ability to work one of the varying shifts to support our 24hr 7 days a week operations
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Proficiency with Microsoft Office Word, Excel, and Outlook
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Knowledge of Medical Terminology, ICD-9/ICD-10 and CPT
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Required to have a dedicated work area established that is HIPAA compliant
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Ability to keep all company sensitive documents secure
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Must live in a location that can receive approved high-speed internet connection or leverage an existing high-speed internet service
