Jobs for People with MS: National MS Society

TEKsystems is hiring a medical review specialist to join our clients team 100% from home! The chosen candidate will have previous experience with medical review and the ability to complete the following tasks:

Description:

Providers bill this team - this role will receive the clinical information from the providers and faxed in requests, will look at the forms and review the case built by Utilization Management, and review member requests for medical necessity. This role will collaborate with their internal team, the Utilization Management team, and with physicians in clinics. This team supports radiology, pharmacy, clinical claims review, and medical cases and will be specialized in one of these areas out of training and will mostly support these specific cases.

Daily Duties:

• This position is accountable for performing medical review to ensure correct dispositions according to all contracts, related endorsements, government regulations and medical policies.

• Responsible for accurate and timely medical review of claims and preauthorization's.

• Responsible for accurate and timely medical review of Customer Service inquiries about claims and preauthorization's.

• Responsible for determining availability of benefits according to company contracts, endorsements and medical policy.

• Responsible for determining member eligibility prior to medical review.

• Responsible for fostering a constructive relationship with all departments.

• Responsible for maintaining professional licensure and practicing within the scope of licensure.

• Responsible for collaborating and consulting with healthcare providers, members, and internal team of clinical support specialists, nurses, physicians, medical directors and pharmacists to ensure medically appropriate, high quality, cost-effective care, promote positive member outcomes, effective use of resources, optimize member benefits, and support business initiatives.

Hours: Monday - Friday 7:30am - 4:00pm or 7:00am - 3:30pm

Skills & Qualifications:

RN licensure

Utilization Management experience - 1+ years

Critical thinking skills

Strong computer skills - will be toggling 4-5 different systems regularly

Positive attitude

Ability to work from home - home set up and reliable internet access

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.