Full-Time
Care Review Processor
Integrated Resources
501-1,000 employees
No salary listed
El Paso, TX, USA
In Person
 Clerical & Data Entry (2) |
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- Accurate data entry at 40 WPM minimum.
- High School Diploma/GED.
- 1-4 years of experience in a Utilization Review Department in a Managed Care Environment.
- Previous Hospital or Healthcare clerical, audit or billing experience.
- Experience with Medical Terminology.
- Top three skill sets: Customer Service, Computer Skills and medical terminology.
- Provide computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: Verify member eligibility and benefits, Determine provider contracting status and appropriateness, Determine diagnosis and treatment request Assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes), Determine COB status, Verify inpatient hospital census-admits and discharges, Perform action required per protocol using the appropriate Database.
- Respond to requests for authorization of services submitted to CAM via phone, fax and mail according to Client’s operational timeframes.
- Participates in interdepartmental integration and collaboration to enhance the continuity of care for Client members including Behavioral Health and Long Term Care.
- Contact physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.
- Provide excellent customer service for internal and external customers.
- Meet department quality standards, including inter-rater reliability (IRR) testing and quality review audit scores.
- Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status.
- Meet productivity standards.
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
Company Size
501-1,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Edison, New Jersey
Founded
1996
Simplify's Take
What believers are saying
- Certification boosts appeal to quality-focused healthcare organizations.
- Reskilling programs cut time-to-hire amid workforce shortages.
- Positions IRI among 15,000 Joint Commission-accredited elite firms.
What critics are saying
- Certification lapses in 12-18 months from failed onsite review.
- Patient complaints trigger decertification and client losses in 6-12 months.
- AMN Healthcare captures IRI's mid-sized clients in 12-24 months.
What makes Integrated Resources unique
- Joint Commission Gold Seal certifies IRI's staffing compliance since 2009.
- AI tool Nova hybridizes with reskilling to close healthcare skills gaps.
- Focuses on diversity hiring and performance monitoring for elite placements.
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Benefits
Wellness Program
Mental Health Support
Flexible Work Hours
Phone/Internet Stipend
Home Office Stipend
Conference Attendance Budget
Company News
Edison, New Jersey - Integrated Resources Inc. has earned The Joint Commission's Gold Seal of Approval(R) for Health Care Staffing Services Certification by demonstrating continuous compliance with its performance standards.
Integrated Resources Inc. has earned The Joint Commission’s Gold Seal of Approval ® for Health Care Staffing Services Certification by demonstrating continuous compliance with its performance standards.