Based on the evolving situation with Covid-19 we are mostly remote, this includes the hiring process. We are in the process of moving to a hybrid of onsite and remote with some positions remaining 100% remote.
Why Is This Role Important To Arcadia
An average day could include; data entry of routine referrals and pre-certification submissions. Review and approval of routine referrals and pre-certifications submitted while following established guidelines. We manage Blue Cross and Humana HMO. Initiates pre-review screening on complex referrals and/or pre-certifications and submit to the Clinical Services Department for review and finalization. Screens potential denials and submits to the Clinical Services Department. Provides clerical support with computer entry, in-going and out-going phone calls.
What Success Looks Like
In 3 months- Team member should be able to understand how to create referral episodes in MCG. Understanding their daily functions like sorting incoming faxes, answering some phone calls and working out of their own IPA folder
In 6 months- Team member should feel very confident with their assigned medical group. Able to take on more responsibilities like learning another medical group and troubleshooting issues with complex cases
In 12 months- Team member should be able to enter 30-40 cases accurately, have all the knowledge of each medical groups process and guidelines, Trouble shoot and help others in the departments, confident in handling phone calls and providing the correct information to our clients.
What You'll Be Doing

• Data entry of referral and precertification's complying with multiple sets of protocols which are built in the application.
• Maintains and manages strict confidentiality of all information, whether received directly or indirectly as it relates to health care services.
• Enter referrals and precertification's into software program accurately using ICD-10 and CPT coding as well as follow necessary guides to maintain compliance with delegation and state requirements.
• Answer phone calls as well as make phone calls.
• Responsible for accuracy and timeliness of referral and precertification's authorizations.
• Assists physician offices and providers with referral and precertification questions.
• Works with Provider Relations and Claims staff to clarify or rectify discrepancies between referrals, precertification's and claims.
• Assists the Clinical Services Department nursing staff in the development and maintenance of internal referral manuals.
• Adheres to all audit procedures.
• Performs other duties as assigned.

What You'll Bring

• Knowledge of medical terminology.
• Preferred medical office experience.
• One years' experience in managed care with referral entry.
• Detailed knowledge of medical coding; including ICD-10, HCPC's and CPT codes.
• Able to adapt to different situations and multitask.
• Must have ability to work independently, maintain organization and meet deadlines.
• Highly skilled in verbal and written communication.
• Able to problem solve, exercise initiative and make decisions.
• Able to communicate clearly and work effectively with co-workers, management, physicians, members, vendors and customers.

Would Love For You To Have

• Knowledge of Excel basic function and PDF Converter and/or Adobe Pro
• Positive disposition
• Hardworking
• Eager to learn daily
• Very dependable
• Works well with others

What You'll Get

• Flexible hours, Working remote, Collaborating with a great team!
• Great benefits, generous time off
• Fully stocked kitchen
• A flexible, remote friendly company with personality and heart
• Employee driven programs and initiatives for personal and professional development
• Be a member of the Arcadian and Barkadian Community

About Arcadia
Arcadia.io helps innovative healthcare systems and health plans around the country transform healthcare to reduce cost while improving patient health. We do this by aggregating massive amounts of clinical and claims data, applying algorithms to identify opportunities to provide better patient care, and making those opportunities actionable by physicians at the point of care in near-real time. We are passionate about helping our customers drive meaningful outcomes. We are growing fast and have emerged as the market leader in the highly competitive population health management software and value-based care services markets, and we have been recognized by industry analysts KLAS, IDC, Forrester and Chilmark for our leadership. For a better sense of our brand and products, please explore our website , our online resources , and our interactive Data Gallery .
This position is responsible for following all Security policies and procedures in order to protect all PHI under Arcadia's custodianship as well as Arcadia Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.