Review Assistant/CSR

Essential Functions: Interprets review guidelines to facilitate forward movement of the case review process including requests for clinical information, treatment plans, discharge dates, and communicating the authorization for requested services. Coordinates, distributes, and tracks highly confidential medical information from multiple sources (fax, web, and phone). Interprets and adheres to URAC standards for assigned programs as well as federal and state requirements. Ensures quality customer service by responding to phone inquiries from members, physicians, and providers. Prioritizes workload to meet program or regulatory time frames. Provides verbal and written communications of review decisions to include administrative denials. Completes service/treatment screens for accurate transmission of outcome decisions. Provides general office support and performs miscellaneous duties as assigned