JOB SUMMARY: Primarily responsible for the initiation of cases by data entry of clinical, demographic and product information into the Medical Management system, via telephone, fax or online portal. Electronically routes cases to the nurse for review and decision. Handles data entry of all precertification of inpatient and outpatient service request. Responsible for accurate case completion /quality and productivity standards while staying within compliance timeframes. Handles provider outbound calls according to departmental standards. Provides a high level of customer service while communicating with internal departments and provider office staff as it pertains to performance of job responsibilities. Works independently with minimal supervision.

MINIMUM QUALIFICATIONS:

1. Education/Specialized Training/Licensure: High School Diploma required. Associate?s degree preferred
2. Work Experience (Years and Area): 2 years? data entry experience in a healthcare setting such as medical clinic, hospital, or managed care. 1 year utilization management experience preferred.
3. Management Experience (Years and Area): N/A
4. Software Operated: Microsoft Office (Word, Excel, Outlook)

SPECIAL REQUIREMENTS: (Check Applicable Areas)

1. Communication Skills:
Writing /Composing: Correspondence / Reports

2. Other Skills: Analytical, Medical Terminology, MS Word, MS Excel

3. Advanced Education:

Advanced Training Specialty: Associate's degree preferred

4. Work Schedule: Flexible

5. Other Requirements:
Able to work independently under general instructions