Description: This position is located in Cypress,CA
JOB SUMMARYThe Utilization (UM) Data Entry Clerk is responsible to enter referrals received in the fax server in accordance with Department TAT and to attach progress notes to existing referrals in the referral operating system.Responsibilities:
- Manage the fax server in the share drive to ensure accuracy and timely data entry of referrals received daily.
- Data entry of each referral to include but not limited to:
- Review and determine to split a referral when necessary,
- Read the source document and verify all required fields are populated prior to data entry,
- Enter applicable data in the required applicable fields in the system,
- Ensure accurate date and time received the same when enter in the system,
- Ensure the accuracy of the source document attach to generated referral in the system,
- Store the completed document in the appropriate folder.
- Monitor hourly incoming STAT referral queue and ensure timely distribution into the IPA queue.
- Timely attaching of progress notes received in reference to existing referrals in the referral operating system and storage of said notes in the appropriate folder.
- Maintain a productivity of 80-100 referrals entered daily.
- Assist UM staff to conduct oral notification to member and document in the system as assigned.
- Report and obtain the directions from UM Manager for any potential delays in referral and/or referral issue.
- Reporting the fax server issues and or malfunctions to IT and UM Manager/Director.
- Assist referral file pull and obtain medical records for health plan audit.
- General clerical duties and special projects as assigned.
- Fosters positive interaction and relationships with all internal departments and staff, as well as external contacts and ensures department resolution of problems.
- Prevent and avoid harassment and discrimination. Respond promptly to any complaints in accordance with policy in employee handbook.
- Adhere to all Tenet Health and Coast Healthcare Management policies and procedures.
- Perform other assigned duties / special projects on an as-needed basis.
- High School Diploma (or equivalent)
- 1+ years’ experience in an IPA/MSO or other health care company
- Data entry experience in a clinical setting using medical terminology, ICD9, and CPT coding
- Knowledge of NCQA, Managed Health Care (DMHC) regulations, Federal ERISA regulations, DHS/Medi-Cal and CMS guidelines
- Knowledge of Essette and Cerecon information system preferred
- Experience with computer programs (Windows, Word, Excel, Mail Merge, Fax Blast, PowerPoint)
- Excellent organizational skills
- Excellent communication and assessment skills
- Willingness to learn new tasks
Job: Clerical/AdministrativePrimary Location: Lakewood, CaliforniaHospital Location: Coast HealthcareJob Type: Full-timeShift Type: Days Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status.
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