Own equipment during review (laptop, desktop, or tablet)
Responsibilities:
Responsible for the review and evaluation of clinical information and documentation, fax triage and conversion, and provider calls.
Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements
Protects the confidentiality of member information and adheres to company policies regarding confidentiality
Data gathering requires navigation through multiple system applications.