Healthcare Management Analyst

Job Description

Healthcare Management Analyst

Associate II – BPM

Who We Are

Advantasure is a growing company and a member of the UST HealthProof family, Advantasure champions innovative solutions with an eye on the future—providing health plans with the flexibility to adapt to a changing regulatory environment and evolving business needs. Leveraging the industry’s leading experts in government-sponsored health plans, Advantasure offers solutions for administrative cost management, quality patient outcomes and experiences, enrollment growth, risk adjustment and quality and provider engagement initiatives.

We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States. **

You Are**

Supports coordination of medical services including briefcases, intake, QIOs, customer service and claims. Promotes and supports care managers and utilization management team as required. **

The Opportunity**

• Provides support services to team members by answering incoming telephone calls, taking messages, researching information, and assisting in solving problems to include assisting members with basic benefit and program information.
• Investigates and resolves Claims issues.
• Investigates QIO requests and provides documentation to support.
• Investigates and resolves briefcase issues.
• Monitors member admissions, enters discharge dates and disposition, refers to needed services in accordance to benefit plan.
• Performs non-medical research pertinent to the establishment, maintenance, and closure of member cases to include the research and resolution of claims issues.
• Maintains accurate and complete documentation of required information that meets quality standards.
• Protects the confidentiality of the member information and adheres to the company policies regarding.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. **

What You Need**

• High school diploma or G.E.D. required.
• Bachelor’s degree in health care or a related field is preferred.
• Current unrestricted LPN license or certified Medical Assistant designation preferred.
• Minimum of one year experience in a health care related field.
• Preferred setting is hospital, medical doctor’s office, or health insurance company.
• Experience with medical terminology and concepts used in the healthcare delivery system, provider office, or the insurance industry is required.
• Computer literacy to include Microsoft Office products, and internal systems to include JIVA, IKA Systems, and Symphony
• Advanced technical skills for use of hardware and software with a high degree of accuracy.
• Excellent oral and written communication skills for representation of clear and concise results.
• Ability to manage significant workload, and to work efficiently under pressure, meeting established deadlines with minimal supervision.
• Strong time management skills.
• Must possess high degree of accuracy, efficiency, and dependability.
• Strong customer service skills to assist members and/or providers with understanding healthcare information and to coordinate issue resolution.
• Effective written and verbal communication and feedback.
• Effective organizational skills with ability to be flexible and prioritize tasks.
• Knowledge of educational assessments and learning strategies.
• Must be knowledgeable of and able to use standard, basic grammar, punctuation, and spelling.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by applicable law, UST provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below. **

Role Location: Remote**

Compensation Range: $45,000-$65,000

Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits. **

What We Believe**

We’re proud to embrace the same values that have shaped UST and its subsidiaries since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone to champion diversity and inclusion and place people at the center of everything we do. **

Humility**

We will listen, learn, be empathetic and help selflessly in our interactions with everyone. **

Humanity**

Through business, we will better the lives of those less fortunate than ourselves. **

Integrity**

We honor our commitments and act with responsibility in all our relationships. **

Equal Employment Opportunity Statement**

UST is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UST reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

#Advantasure

#CB