Medical Review Analyst II at Elevance Health in Roanoke, Virginia
Posted in Other about 19 hours ago.
Job Description:
Medical Review Analyst II
Location: This is a remote position. Ideal candidates will live within 50 miles of one of our PulsePoint office locations.
Work Hours: This is a day shift working Monday through Friday. Holidays, evenings, and weekends may be required based on business needs.
The Medical Review Analyst II is responsible to provide non-clinical review and analysis of all non-complex and some complex Tier I post service medical claims.
How you will make an impact :
- Utilizes guidelines and review tools to analyze assigned claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.
- Reviews, analyzes and renders determinations on assigned non-complex and some complex Tier I requests.
- Serves as a liaison between medical management and/or service operations and other internal departments.
- Serves as an internal resource for associates.
- Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
- Prepares cases for clinical review and completes reviews using nonclinical scripts.
Minimum Requirements:
- Requires a HS Diploma or equivalent and a minimum of 5 years of claims processing or customer service experience with managing complex claims, provider, or member issues; or any combination of education and experience which would provide an equivalent background.
- Experience with medical coding and medical terminology required.
- Knowledge of provider networks, the medical management process, internal business processes, and proficiency with internal local technology required.
Preferred Skills, Capabilities & Experiences:
- Self-motivated, independent, flexible, and ready to learn new applications and processes.
- Strong oral, written and interpersonal communication skills, problem-solving skills.
- Proficient use of computers and multiple monitors.
- Experience with Microsoft applications such as Outlook, Word, Excel, OneNote and MS Teams is preferred.
- Experience working in a production environment
- Experience working in ACMP, GBD Facets, Macess and NextGen is preferred.
- BA/BS preferred.
- Claims processing experience preferred
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