Medical Information Specialist

Job description

Shift – 8:30am-5:00pm M-F; shift bidding process based on seniority. Site/Location: Detroit, MI: Status – Regular Full Time: Provide thorough analysis and investigation of authorization requests for specialized medical/surgical/outpatient procedures in an expeditious and accurate manner ensuring provider, hospital/facility, Primary Care Group (PCG), and member quality customer service. Provide information and assistance pertaining to the Medical Management program to providers, hospitals, PCGs and members. - Assess and investigate requests for medical service authorization and authorize select services that do not require clinical judgment. Collect and record appropriate data to issue authorization and route request for services that require medical review to appropriate team member(s). - Facilitate communication with providers regarding status on authorizations and referrals. Identify relevant issues and route to appropriate department for action and resolution. - Perform departmental functions such as: data preparation/presentation, interaction with internal and external sources to resolve inquires, assist with on-the-job training of new employees as requested, educate and direct...