Preauthorization Intake Jobs

Once the training is completed, after the first 60 days, this position is a hybrid role with 3 days remote and 2 days in office. The successful candidate will have a solid medical background/medical terminology, have advanced computer literacy skills, type 45-50 WPM, demonstrated critical thinking skills and ability to produce in a fast-paced environment within the established time limits. Process incoming requests for preauthorization from health care providers or injured employees. Collect clinical data to support the request in order to forward the file for nurse review. Compile, process and maintain medical records of injured employees in a manner consistent with medical, administrative, ethical, legal and regulatory requirements of the health care system. Relies on instruction and pre-established guidelines to perform the functions of the job. Familiar with standard concepts, practices, and procedures within the medical field. Familiar with Division of Workers' Compensation and the Texas Law regarding workers compensation. Compile and Maintain Injured Employee Medical Records to document condition and treatment and to provide data for preauthorization determinations Resolve/ Clarify requested treatment codes and diagnosis codes with conflicting, missing or unclear information by consulting with providers or customers to get additional information to complete request for preauthorization Review and label 60+ faxes daily for completeness, accuracy and compliance with regulations Send 30+ e-faxes daily consisting of determinations or invalid requests Protect the security of medical records to ensure confidentiality is maintained Enter data, such as demographic characteristics, history or extent of injury, diagnostic procedures, disputes and treatment in computer Email notifications to clients and obtain all additional information for record completeness Obtain preauthorization determinations from nurse or physician advisor and release determination to requestor