Job Title: Care Access and Monitoring (CAM) Data Entry Specialist
Location: 100% Remote
Time Zone Requirements: EST time zone
Job Type: Full-Time
Schedule: 8:00 AM to 5:00 PM
Overview: The Care Access and Monitoring (CAM) Data Entry Specialist will provide clerical and data entry support for Managed Care Organization members requiring hospitalization and/or utilization review for other healthcare services. Responsibilities include checking eligibility, verifying benefits, data entry, and triaging information to the appropriate Health Care Services staff to ensure the delivery of high-quality, cost-effective healthcare services according to State and Federal requirements.
Must-Have Requirements:
- Knowledge of Microsoft Office products
- Healthcare experience
Day-to-Day Responsibilities:
- Provide computer entries for authorization requests/provider inquiries via phone, mail, or fax, including:
- Verifying member eligibility and benefits
- Determining provider contracting status and appropriateness
- Determining diagnosis and treatment requests
- Assigning billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes)
- Determining COB status
- Verifying inpatient hospital census (admissions and discharges)
- Performing required actions per protocol using the appropriate database
- Respond to requests for authorization of services submitted to CAM within operational timeframes
- Participate in interdepartmental integration and collaboration to enhance continuity of care for members, including Behavioral Health and Long-Term Care
- Contact physician offices as per department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director
- Provide excellent customer service to internal and external customers
- Meet department quality standards, including inter-rater reliability (IRR) testing and quality review audit scores
- Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status
- Meet productivity standards
- Maintain confidentiality and comply with HIPAA
- Participate in CAM meetings as an active team member
- Follow attendance guidelines and standards of conduct as per Managed Care Organization HR policy
- Comply with required workplace safety standards
Knowledge/Skills/Abilities:
- Ability to communicate, problem-solve, and work effectively with people
- Working knowledge of medical terminology and abbreviations
- Analytical thinking and problem-solving skills
- Good communication and interpersonal/team skills
- High regard for confidential information
- Ability to work in a fast-paced environment
- Ability to work independently and as part of a team
- Proficient computer skills and experienced user of Microsoft Office software
- Accurate data entry at a minimum of 40 WPM
Required Education:
- High School Diploma/GED
Required Experience:
- 0-2 years of experience in a Utilization Review Department in a Managed Care Environment
- Previous hospital or healthcare clerical, audit, or billing experience
- Experience with medical terminology