Acentra Health, LLC

The Customer Service Representative will be responsible for answering incoming calls, addressing customer questions, resolving concerns, and fulfilling service requests while adhering to internal policies. Key duties include developing knowledge of internal policies, utilizing automated systems for logging information, and interacting with hospitals, physicians, and beneficiaries.

The role involves building, optimizing, and integrating Machine Learning (ML) and Large Language Model (LLM) solutions, focusing heavily on Generative AI, RAG, and NLP to improve healthcare outcomes and efficiency. Key tasks include designing and deploying LLM-powered applications, building RAG pipelines, supporting MLOps/LLMOps practices, and mentoring other engineers.

The Scheduler is responsible for streamlining appointment coordination, including scheduling consultations according to procedures, arranging transportation details, and ensuring consultations are completed promptly. This role also involves following up on consultations, rescheduling missed appointments, assigning second opinion numbers, generating necessary forms and letters, and maintaining a database for prompt response to inquiries.

The Clinical Reviewer uses clinical expertise during beneficiary interaction to communicate medical appropriateness while adhering to contract requirements, production goals, and quality assurance standards. Responsibilities include assessing daily workload, collaborating on quality monitoring, maintaining knowledge of review processes, and acting as a liaison for provider customer service issues.

The Clinical Reviewer will leverage clinical expertise to conduct comprehensive medical record reviews, ensuring alignment with established clinical criteria and contract requirements for the state of Maine. Responsibilities include managing daily workloads, meeting production targets, upholding quality standards, and serving as a liaison to providers.

The Clinical Assessor will conduct comprehensive, needs-based eligibility assessments for individuals applying for Medicaid-funded personal care services to determine level-of-care criteria. This involves interviewing beneficiaries and caregivers to support person-centered determinations enabling individuals to remain in or transition back to home and community-based settings.

The representative will handle front-line service by answering incoming calls from state benefit system members and providers regarding eligibility, benefits, claims, and authorization of services. Responsibilities also include resolving complaints, researching information, educating providers on claim submission, and performing necessary follow-up tasks.

The Clinical Reviewer uses clinical expertise during beneficiary interaction, along with critical thinking and decision-making skills, to communicate medical appropriateness while meeting production and quality assurance standards. Responsibilities include assuring accuracy and timeliness of reviews, assessing daily workload, and acting as a liaison for provider customer service issues.

The primary duties involve answering incoming telephone calls, resolving customer questions, complaints, and requests while adhering to internal policies. Responsibilities also include utilizing automated systems, interacting with external partners like hospitals, and performing verification of healthcare services.

Acentra Health is looking for a Clinical Reviewer - RN (Remote U.S.) to join our growing team. Review medical records against criteria, contract requirements, and regulatory standards. Employ critical thinking to determine medical appropriateness while meeting production goals an...