Therapist Reviewer

Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.This is an exceptional opportunity to do innovative work that means more to you and those we serve. Location: Houston or Dallas, Texas The person in this position must work in our Houston or Dallas location. Remote work will be considered after 90 days. The Therapist Reviewer Sr (Speech Pathologist Therapist) is responsible for the review of medical records, including more complex cases, to determine if requests for therapy services (speech-language pathology) are medically necessary and filed appropriately. Primary duties may include, but are not limited to:

Applies professional therapy, government regulation and medical policy knowledge to medical review, and makes determinations for authorization requests, meeting all contract requirements, processes and operational unit goals to ensure customer satisfaction.

Maintains knowledge of regulations and requirements through review of current regulations and/or policies.

Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements.

Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary.

Acts as a resource for internal and external customers.

Participates in or leads intradepartmental teams, projects and initiatives.

Maintains quality and productivity standards, and ensures reviews are conducted within required timeframes.

Qualifications

Graduate of a college level program in speech-language pathology, 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background.

Current active unrestricted license as a speech language pathologist assistant in applicable state required.

At least 5 years of experience is preferred.

Pediatric experience preferred.

Home Health Care experience preferred.

Microsoft Office knowledge preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 REQNUMBER: PS37545