Overview
Remote
Depends on Experience
Contract - W2
Job Details
Care Review Processor | 2+ years | Remote | Contract
Walker Healthforce is seeking a Care Review Processor with 2+ years of experience to support a healthcare client. This is a 6-month contract opportunity.
START DATE: 10/1/2025
HOURS/SCHEDULE: 8a-5p EST for training then 9a-6p EST Monday-Friday; Hrs/Wk:40.00 Est. OT Hrs/Wk:5.00
WORKER TYPE: W2
CORE REQUIREMENTS:
JOB RESPONSIBILITIES:
WHAT WE OFFER:
WHY WORK WITH WALKER?
Contact our Recruiting Team today to experience the Walker Healthforce difference!
ABOUT US:
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!
We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.
#IND2
Walker Healthforce is seeking a Care Review Processor with 2+ years of experience to support a healthcare client. This is a 6-month contract opportunity.
START DATE: 10/1/2025
HOURS/SCHEDULE: 8a-5p EST for training then 9a-6p EST Monday-Friday; Hrs/Wk:40.00 Est. OT Hrs/Wk:5.00
WORKER TYPE: W2
CORE REQUIREMENTS:
- 2+ 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
- Demonstrated ability to communicate, problem solve, and work effectively with people
- Working knowledge of medical terminology and abbreviations
- Ability to think analytically and to problem solve
- Good communication and interpersonal/team skills
- Must have a high regard for confidential information
- Ability to work in a fast-paced environment
- Able to work independently and as part of a team
- Computer skills and experienced user of Microsoft Office software.
- Accurate data entry at 40 WPM minimum
- High School Graduate
JOB RESPONSIBILITIES:
- Provide computer entries of authorization request/provider inquiries by phone, mail, or fax
- 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 operational timeframes
- Participates in interdepartmental integration and collaboration to enhance the continuity of care for 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)
- Participate in Care Access and Monitoring meetings as an active member of the team
- Meet attendance guidelines
- Follow Standards of Conduct guidelines
- Comply with required workplace safety standards
WHAT WE OFFER:
- Competitive compensation package
- Weekly pay via Direct Deposit
- Medical, Dental & Vision available
- 401k options
WHY WORK WITH WALKER?
- Access to our top ranked team of recruiting and placement specialists
- Continuous, one-on-one support from a dedicated engagement manager
- Professional resume development and interview preparation
Contact our Recruiting Team today to experience the Walker Healthforce difference!
ABOUT US:
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!
We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.
#IND2
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.