Location: Cheyenne, WY 82001
Xerox Business Services, LLC is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, sex, marital status, sexual orientation, physical or mental disability, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by Federal or State law or local ordinance. People with disabilities who need a reasonable accommodation to apply or compete for employment with Xerox Business Services, LLC may request such accommodation(s) by sending an e-mail to accommodations@xerox.com.
Xerox is the world's leading enterprise for business process and document management. Its services, technology, and expertise enable workplaces - from small businesses to large global enterprises - to simplify the way work gets done so they operate more effectively and focus more on what matters most: their real business. Xerox offers business process outsourcing and IT outsourcing services, including data processing, healthcare solutions, HR benefits management, finance support, transportation solutions, and customer relationship management services for commercial and government organizations worldwide. The company also provides extensive leading-edge document technology, services, software and genuine Xerox supplies for graphic communication and office printing environments of any size. Xerox serves clients in more than 160 countries. For more information, visit www.xerox.com, www.news.xerox.com, www.realbusiness.com orwww.xerox.com/businessservices
If you meet the requirements of this position and want to work for a world-class company with a great marketplace reputation, apply today.
Description:
If you meet the requirements of this position and want to work for a world-class company with a great marketplace reputation, apply today.
Description:
The Medical Policy Specialist is responsible for completing the Medical Policy processes according to contractual requirements, this includes but not limited to entering the Prior Authorization (PA) data, updating Procedure, Drug and Diagnosis(PDD) file and communicating with the providers, making sure the PA and PDD goes to QA and then to scan. They must accurately and timely work the Edit locations assigned to Medical Policy. They are also responsible for assisting the State in identifying fraud and abuse. The position receives referrals, opens cases and completes initial reviews according to contractual requirements, review edits and use fraud detection tools. This position is also responsible for mail merging and sending out EOMB letters. Responses to the EOMB letters must be logged and reviewed for possible cases. CURT Cases are presented to the State on a bi-monthly basis. Recoveries are completed as requested by the state. This position may require other duties as assigned by the Medical Policy Manager.
Major Position Responsibilities:
Screen PA for all documentation and enter it into the MMIS system within 2 business days.
Communicates with providers if documentation received is incomplete or missing.
Sends PA approval or denial letters to providers within 2 business days after review.
Sends completed PA to QA and then to Scan.
Receive, open and review cases for SURS according to contractual requirements
Maintains a phone line for providers. Documents all calls.
Receives and processes PDD requests from the state within 2 business days.
Meet internal quality standards.
Mail merge EOMBs, send, review and log returns
Complete recoveries at the State’s request.
Order medical records as necessary.
Review EFADS filters on a quarterly basis and present to CURT.
Attend the CURT bi-monthly meeting and present cases.
Work medical policy edits accurately.
Other duties as assigned.
Required Qualifications:
Strong communication skills both written and oral.
Be able to maintain confidentiality and security.
Strong analytical, comprehension, and problem solving skills.
Be able to work under pressure and with little supervision.
Must be able to work overtime when required.
Ability to follow oral and written instructions and directions.
Personal computer experience
Strong customer service skills.
Must be detailed oriented.
Must have good organizational skills and decision-making ability.
Must be able to work independently and as a team member.
Excellent attendance required.
Preferred Qualifications:
Medical background of some kind.
Knowledge of durable medical equipment.
Sensitivity of POSITION:
Works with protected health information (PHI).
Xerox Business Services, LLC is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, sex, marital status, sexual orientation, physical or mental disability, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by Federal or State law or local ordinance. People with disabilities who need a reasonable accommodation to apply or compete for employment with Xerox Business Services, LLC may request such accommodation(s) by sending an e-mail to accommodations@xerox.com.
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