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MEMBER SERVICE REPRESENTATIVE/PHONES
Utilization Review Nurse - RN
MEMBER SERVICE REPRESENTATIVE/PHONES
Posting Date: 07/20/2010
Closing Date: Until Filled
Reports to Team Coordinator
Non-Exempt, Non-Supervisory Position
Responsibilities
Will respond to and refer Member and Provider inquiries, perform data entry of inquiries and referrals, verify benefits, and assists in claims adjudication. Is able to effectively and efficiently assess and respond to Member/Provider and group inquiries, including strong closure skills. Responds to Provider inquiries, verbally and written via online requests. Is able to effectively present information to Providers and/or Members telephonically. Protects the confidentiality, integrity and availability of information and records that TML IEBP creates, receives, maintains or transmits by complying with TML IEBP policies and procedures, including policies and procedures on physical, administrative and technical safeguards.
Qualifications/Skills Required
Must have one year customer service and or outbound calls and a minimum 3 years experience in healthcare. Must have a working knowledge of medical terminology, managed care contracting, medical/dental/vision processing principles, and benefit administration. Is able to provide 6.5 manned phone hours per day and log required calls per day as defined by the specific range criteria the individual occupies with minimum quality rating of 95% and or a 5 minute or less talk time average. Will effectively and efficiently assesses and responds to Member/Provider and group inquires, including strong closure skills. Bilingual skills, both written and verbal preferable to effectively service our Member population. Is able to type 40 words per minute and ten-key by touch is required. Must also have the ability to effectively work in a team environment and perform multi-task job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. eoe
TO APPLY
Please submit your resume with a cover letter to Human Resources. Indicate the position you are applying for and detail how you meet the qualifications listed. You may fax this information to (512) 719-6717 or mail it to:
TML IEBP
Attn: Human Resources
P.O. Box 140644
Austin, TX 78714-0644
You may also submit a Pre-application for Employment online. Click here to begin the application process.
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Utilization Review Nurse - RN
Posting Date: 07-12-2010
Closing Date: Until Filled
Reports to Team Coordinator/Manager
Exempt - Non-Supervisory
Responsibilities
Performs telephonic precertifications, concurrent review, retro/claims reviews, and discharge planning while ensuring quality customer service. rotects the confidentiality, integrity and availability of information and records that TML IEBP creates, receives, maintains or transmits by complying with TML IEBP policies and procedures, including policies and procedures on physical, administrative and technical safeguards
Qualifications/Skills Required
A Texas Licensed RN with 3-5 years of Med/Surg experience and prior utilization review experience. Requires computer data entry skills. Experience with Interqual highly preferred. Ability to work independently, effective communication skills and strong organizational skills are also strongly preferred. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
TO APPLY
Please submit your resume with a cover letter to Human Resources. Indicate the position you are applying for and detail how you meet the qualifications listed. You may fax this information to (512) 719-6717 or mail it to:
TML IEBP
Attn: Human Resources
P.O. Box 140644
Austin, TX 78714-0644
You may also submit a Pre-application for Employment online. Click here to begin the application process.
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