robotech_master: (energy ball)
[personal profile] robotech_master
Well, work training proceeds apace.

My job is going to be a Utilization Management representative. That means I handle precertifications (the mandatory cases where a particular course of treatment has to be approved by the insurance company prior to it being covered) and predeterminations (the optional-but-recommended cases where the treatment can be submitted for approval ahead of time, or can be submitted at the time the claim is turned in instead).

The way it works is, I answer the phone when a doctor, nurse, physician's assistant, or occasionally patient or their family member calls in to check and see if pre-C or pre-D is needed. I check to see if it is or not, and if it is I take down their information, enter it into the system, tell them where to send the clinicals, and give them a reference number. Or, if they're calling to check on one that's already been put in, I look it up for them.

For the past week and a day, I've been sitting with my "preceptor"—the experienced representative who has been showing me the ropes—and spending part of each day working the computer while she's managed the calls by voice. Tomorrow, I'm going to be taking my first shots at talking on the phone myself while I do it, still under her supervision.

The more I do of it, the easier it gets. But the biggest problem, I think, isn't so much the process—it's all the little exceptions and things that have to be done slightly differently for slightly different cases. It's a little hard to remember some of them, and the only way to get it is by repetition. I don't know if I'll really be ready for it by the time this week ends and I'm on my own starting next Monday. I hope I pick up enough of it the rest of the week. I do still have four more days of working on it with her for my preceptor to bang it into my head, and she's done pretty well so far—I've picked up a lot more than I'd expected I would this time last week. It's certainly a lot harder than the customer service job—and one amusing thing is learning just how much of what I was told about precertification in training for my customer service job was inaccurate or just plain wrong!

Meanwhile, after work today I stopped and checked into the little mini-clinic built right into the building where I work. Needless to say, they'll accept my job-given insurance, which will be active as of July 1. I checked with my regular doctor and found that she can't see me until July 14th—but there's a regular doctor at the clinic at work, and they're open to seeing me sooner, and might even end up becoming my primary care physician. And they're certainly a lot closer than my regular doctor, so there's the convenience thing too. I've already put in a request to the office of my old regular doctor to fax my medical records over.

A couple of nice things about said clinic: first off, if I get prescribed medicines by the doctor there, and pick them up at that clinic, they're effectively free. And second, they have one of those home sleep study gizmos they can send home with me—a machine I hook up and sleep with for three nights, that will transmit information about my sleeping habits back to home base for analysis so I might well end up able to get a CPAP. I already have plenty of friends and brothers who use such things. If they make such a difference for them, maybe they can help me too.

In any event, I'm doing the best I can to make the best of things and get good at my new job. I hope I don't screw it up too badly in days to come. Whatever happens, I'm probably going to be doing it for about 11 more months before I can apply for other internal Anthem postings. Hopefully it will get less stressful once I understand it better.
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