Humera Review Coordinator I in Minnetonka, Minnesota
Review Coordinator I|Minnetonka, MN
Review Coordinator I
Humera is seeking multiple Review Coordinator for our client in Minnetonka, MN. The individual's in this role are responsible for coordinating all intake functions into the Utilization Management and Clinical Appeals Department in accordance with all department policies,
regulatory and accreditation requirements. It triages, and appropriately processes all information received by the Utilization Management and Clinical Appeals Department. This is a critical role,
as downstream activities, such as pre-service authorization, case management and appeals depend upon the timely, accurate processing of information to perform their job functions and ensure
regulatory and accreditation standards are met. This is a contract to hire opportunity.
Process Initiation - 40%
- Processes all incoming calls, faxes, letters, and email
communications using various software applications.
- Researches and reviews all incoming requests for
appropriateness against requirements.
- Distributes, as appropriate, and redirects to other departments
Identifies and communicates trends to leadership.
Responsible for coordination of resources to resolve provider
and member concerns.
- Provides overview of review process and expected turn around
time information to providers if requested.
- Distributes cases and reviews based on department developed
- Educates customers to prevent service problems for members
- Initiates requests of Utilization Management and Clinical
Appeals (to include, but not limited to, admissions, referrals,
prior authorizations, retro reviews, concurrent reviews and appeals
cases) in CCMS within 24 hours of written
Process Administration - 20%
- Proficiency in and knowledge of notification, prior
authorization, case management, and clinical appeals
- Identifies and communicates to department leadership
opportunities for improvement and/or enhancements in provider
and/or member relationships. (Including but not limited to trends
and possible problems in referrals, prior authorization,
notification, utilization management, and clinical appeals
- Documents pertinent information in appropriate electronic
- Identifies processing errors, misdirected information, other
issues, accurately assessing the cause of the problems. Brings
trends to leadership.
- Applies and processes notification requests based on department
standards, specific group requirements, and product
Projects/Team Accountabilities - 20%
Completes projects and assignments as directed.
Participates in committees and/or projects as assigned.
Takes accountability for attending team meetings, 1:1 meetings
and performance review of daily work.
Data Systems - 10%
- Demonstrates proficiency in and knowledge of required
electronic systems (including but not limited to Iset, Qstar, CCMS,
MN-ITS, KN, KL, and Right fax) when processing notifications,
referrals, and prior authorizations.
Policy and Procedures - 10%
- Assists with development of new or revisions of existing work
flows and or Standard Operating Procedures to assure accuracy.
- Completes policy reviews and trainings in a timely manner to
ensure accuracy in process and that compliance measures are
- Complies with all department policies and regulatory and
Experience & Education
Associates Degree preferred.
A minimum of 6 months to 1 year of experience.
One year experience in the health care industry.
Knowledge and understanding of medical terminology, and coding experience.
1 year managed care and/or health insurance experience.
Skills and Abilities
Proficient in investigation and problem solving activities
Strong verbal and written communication skills
Attention to detail and accuracy
Ability to multi-task
Strong organization skills
Customer service – both internal and external
Strong interpersonal skills
Flexibility in handling changes in work assignments and environment
Ability to use Word and Excel at an intermediate level
Post Date: 09.19.2018
Salary: Contact for Rate