Job descriptionJob Description:
Client Response Coordinator Support Specialist (CRSS) are committed to support the necessary processes required for courtesy reviews, pre-service appeals and all external reviews. The CRSS handles the Non-Clinical processes that support the clinical staff to reach appeal determination and notification within all applicable turnaround (TAT) guidelines. They will have a beneficial impact in the navigation of an intricate appeal process and keep disruption to members at a minimum.
- Manages Courtesy Reviews, Pre-Service appeals and all External Reviews accurately. Will collaborate with Medical Management appeals team to for appeals regarding initial pre-certification denials. Ensures compliance with Department of Labor regulations, plan specifications and ERISA turnaround times.
- Navigates proprietary software systems to respond to expedited requests.
- Handles all provider outreach calls to educate on necessary forms required to appeal.
- Ensures compliance with HIPAA and HITRUST information security requirements to protect client information.
- Provide administrative, research and clerical support for the team.
- Adheres to AmeriBen culture by demonstrating Integrity, Initiative, Good Judgment, and Teamwork.
- Performs other duties as assigned to ensure individual and group goals are achieved with Accuracy, Customer Service and Timely Turnaround.
- High school degree, or equivalent.
- Proficiency with Microsoft Office products.
- Strong verbal and written communication skills.
- Ability to work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines.
- Strong research and organizational skills.
- Must be self-directed and work well with others.
- Types 45 wpm, 10-key, and computer knowledge.
AmeriBen is not yet hiring in the below states:
- Delaware, Massachusetts, Montana, New Hampshire, New York, North Dakota, Rhode Island, South Dakota, Vermont, District of Columbia and Puerto Rico.
AmeriBen is an Equal Opportunity/Affirmative Action Employer committed to creating an environment of diversity and inclusion for equal employment and advancement opportunities to all employees and applicants for employment. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, national origin, sex, sexual orientation, gender identity and/or expression, genetic information, disability, veteran or military status, or any other category protected by federal, state and/or local law.
If you are unable to use our online application process due to a disability, please contact the Human Resources Department at [email protected] .