Support Services Specialist

Health Net, Inc. (NYSE: HNT) is among the nation's largest publicly traded managed health care companies. Health Net's mission is to help people be healthy, secure and comfortable. The company's POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company's Web site at www.healthnet.com



JOB SUMMARY:



The Support Services Specialist acts as the operational resource person and correspondence technician for the Medical Management Department. Responsible for the accurate completion, issuing and tracking of approval, adverse determination and post-service determination letters. This position would work closely with clinical operations and Quality Management to ensure that requests are in compliance with timeliness guidelines.



ESSENTIAL DUTIES AND RESPONSIBILITIES: Logs in administrative, clinical denial, and post -service requests into central database. Ensures that all denial requests are complete with appropriate clinical or administrative information, and that requests are in compliance with URAC, CMS and NCQA requirements. Ensures that all requests meet state specific, timeliness and regulatory guidelines. Completes all administrative denial letters, ensuring that provider and recipient information is accurate. Completes clerical/ and or authorization documentation in clinical records. Completes all clinical denial letters, ensuring that appropriate template has been selected, denial language appropriate and contains clinical criteria, and denial reason. Reviews and edits all correspondence before mailing. Requests additional information from clinical operations care managers and medical directors as needed to complete denial requests. Cross trains on multiple lines of business to back up other support teams in the Medical Management Department (Post Service Review and National Support Unit). Completes special projects as assigned. Assists with mailings and filings as needed.
REQUIREMENTS


REQUIREMENTS:



Education:

Requires high school diploma; Associate's/Bachelor's Degree preferred, or equivalent work experience.



Certification/License:



Experience:

Minimum three years experience in an office setting or two years in health care.



Knowledge, Skills & Abilities:Ability to type 45 words per minute and proficient computer skills, including Office 2003, Microsoft Access and Excel Databases. Ability to comprehend and follow detailed procedural guidelines. Must have excellent writing / editing skills. Must be able to compose clear documentation using correct format, spelling and grammar. Must be able to communicate clearly and effectively. Must be able to work in a busy, demanding environment with tight timelines.

OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.



Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.



Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.