PHP Representative

PHP Representative

Job Description
Job Code: NI9602N


Purpose/Scope of Position: This function exists in order to respond to and
appropriately triage calls from physicians, health plans, and, on occasion,
concerned members who are attempting to evaluate the status of an imaging
request or wish to register a reconsideration, appeal, or complaint/grievance. In
addition, this position will generate all responses to appeals.


Responsibilities/Duties:

* Staff the physician call back line and triage requests for peer-to-peer
discussions to the appropriate physician.

* Handle phone call directly if information needed is administrative in nature.

* Respond directly to requests regarding the status of an authorization.

* Successfully manage member concerns that are forwarded from the Call
Center or received directly.

* Triage creation of authorization with Authorization Services Supervisor as
directed.

* Look up authorization numbers for faxes and other documents related to a
determination.

* Maintain organization of recent faxes to and from plans for ready retrieval.

* Provide back-up support as an authorization representative.

* Provide back-up support as an authorization clerk as needed.

* Maintain organization of recent voicemail messages from providers for ready
retrieval


Knowledge, Skills & Abilities:

* Knowledge of medical terminology and transcription

* Typing skills of at least 55 WPM

* Excellent customer relations skills

* Excellent telephone skills

* Excellent organization and multi-tasking skills




Education & Experience:

* High School diploma required

* At least six months experience as an authorization representative in a
utilization management call center
* Experience with a desktop computer and software such as Microsoft Office


Physical Demands:

* Must be able to sit at a desk with a headset and answer telephone calls for 8
hours a day