🔆 GoodLeap is America's leading fintech for sustainable home solutions.
Contract Review Specialist
Location
California
Posted
1 day ago
Salary
$17 / hour
Seniority
Senior
Job Description
Contract Review Specialist
GoodLeap
• Completing contract review cases in Origin portal for loans to progress forward to NTP (notice to proceed) and funding. • Contract Review Specialists are responsible for reviewing and ensuring home improvement contracts (HIC) that are uploaded by approved Solar/ Home improvement partners are compliant and meet Goodleap guidelines/policies.
Job Requirements
- Able to work efficiently and with detail
- Ability to work overtime on short notice
- Ability to work in a fast-paced environment
- Fast learner required
- Ability to adjust to changes in process/procedures
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• Perform utilization and concurrent reviews of inpatient cases using Milliman, Aetna, and BCBS criteria. • Conduct medical necessity reviews for services requiring prior authorization, applying utilization-specific criteria. • Request and evaluate clinical information needed to review requested services. • Discuss cases and determinations with healthcare professionals and physician reviewers. • Identify cases requiring intervention and collaborate with Case Managers as needed. • Maintain appropriate and accurate documentation, ensuring compliance with audit standards. • Participate in team meetings, educational sessions, and related activities. • Review medical claims and pre-determinations for medical necessity and appropriateness. • Identify opportunities for process improvement and enhance communication among departments. • Consult with Physician Reviewers for complex or challenging cases.
• Perform utilization and concurrent reviews of inpatient cases using Milliman, Aetna, and BCBS criteria. • Conduct medical necessity reviews for services requiring prior authorization, applying utilization-specific criteria. • Request and evaluate clinical information needed to review requested services. • Discuss cases and determinations with healthcare professionals and physician reviewers. • Identify cases requiring intervention and collaborate with Case Managers as needed. • Maintain appropriate and accurate documentation, ensuring compliance with audit standards. • Participate in team meetings, educational sessions, and related activities. • Review medical claims and pre-determinations for medical necessity and appropriateness. • Identify opportunities for process improvement and enhance communication among departments. • Consult with Physician Reviewers for complex or challenging cases.


