Evolent Health Customer Service Representative, Technician, UM in Austin, Texas
Excellent hourly rates’ and future work from home ability
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
Responsible for support of utilization management process including verification of eligibility, benefits, and coverage, recording demographic information for precertification requests, maintaining the Utilization Review database, generating approval and denial letters, answering phones, and general administrative support.
- High School Diploma or equivalent required.
A minimum of 1 year of experience is required in data entry and general office duties.
Experience in a health care environment and familiarity with ICD-9 and CPT coding and/or medical terminology preferred.
Candidate must demonstrate proficiency using a PC
Experience with Microsoft Office Suite and Access preferred.
Accurate data entry skills.
Strong attention to detail and organization.
Good interpersonal, oral and written communication skills.
All duties are performed in a controlled office environment; desk work may involve extended periods of sitting, phone time, typing on PC keyboard.
Performs intake of preauthorization requests including demographic and provider information, completing required fields inclusive of ICD-9 and CPT coding, and verifying eligibility in accordance with member’s benefit package and client specifications
When performing initial screening, non-clinical administrative staff are limited to the following functions:
Performance of review of service request for completeness of information;
Collection and transfer of non-clinical data;
Activities that do not require evaluation or interpretation of clinical information
Licensed Health Professionals are available by telephone and/or email to non-clinical staff when performing initial screening.
Performs data entry and data retrieval activities as required.
Acts as Appeals Coordinator for all provider and member Medical Management appeals, which includes maintaining the Appeals Log, coordination with the Patient Care Manager and Physician Reviewer, referring cases, as appropriate, to the Client/Health plan, and assisting with appeal letters
Initiates Discharge Follow-up Calls as per protocol and refers appropriate cases to nurse for follow-up within established time frames.
Maintains the integrity of the utilization database through timely processing of all admissions and discharges within position scope.
Generates approval and denial letters as directed by the Patient Care Managers
Provides administrative support to the Medical Management team including answering phone queues within established standard timeframes and other general clerical functions.
Other duties as assigned.
Evolent Health is an Equal Opportunity/Affirmative Action Employer