Healthcare Analyst

Position Title: Healthcare Analyst

Duration: 12 Months with possibility of extension

Location: Remote

Shift hours: 9:00a - 5:30p Mountain Time Monday - Friday.

NOTE: Candidate can reside anywhere in the US (must be able to work 9-5:30 MST)

Position Summary

Healthcare Analyst position would work within the Commercial and IFP membership of the Behavioral Health Division of company.

Would work closely with Medical Directors, Clinicians and Customer Service to process higher level reviews.

The Healthcare Analyst would be an integral part of managing our state policies, our NCQA accreditation, and helping our members get the help and documentation that they need.

Duties

Provide service to clinical teams in support of optimal care.

Generates administrative and medical necessity denial letters, checking for accuracy and appropriateness.

Makes calls to providers and utilization reviewers to provide results of medical necessity determinations and provides specifics for next steps.

Schedules and coordinates appointments between providers or attending physicians and company Medical Directors or Consultants.

Collects and provides necessary material for appointments. Calculates deadlines for appointments and monitor cases for timely return.

Complies with state mandated and company regulations by monitoring documentation, checks for nuances before action taken and follows varying protocols by case or situation.

Required Qualifications

2 plus years experience in health insurance field and/or

Associates Degree

2 plus years Administrative/ Secretarial experience and/or

2 plus years Customer service experience within health care or a mental health capacity

Ability to type 60-70 words per minute (please included typing test at top of resume)

Experience in using Microsoft Office including Word, Outlook and Excel

Preferred Qualifications

Good organizational skills

A go-getter who works independently

Excellent communication