Massachusetts Veterans Jobs

Remote position but will be required to go on site as needed.

Job Description

Coordinates the review process for services requiring prior authorization by *. This includes matching the coverage request to the Medical Necessity Guidelines/Interqual Criteria or Plan Benefit Documents, documentation of the coverage determination in electronic clinical documentation systems, and notification to the requesting provider of coverage determinations within established time frames.

Collects all documentation necessary for coverage determinations and prepares cases for Medical Director Review, including the procurement of Plan Benefit Documents and Medical Necessity Guidelines, documents Medical Director coverage determinations. Notifies providers and/or members of the coverage determination within established time frames.

Interprets Plan Benefit Documents for all products to ensure appropriate benefit determination.

Assists Member and Provider Services in responding to external coverage inquiries.

Is responsible for drafting written correspondence to members and providers pertaining to coverage determinations based on explicit instructions and specific guidelines.

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com/) .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.