Utilization Support Coordinator

COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for Medicare recipients. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

SUMMARY DESCRIPTION:

The Utilization Support Coordinator will provide internal support to the Health Services Department and may be assigned in the areas of Utilization Management or Care Management ensuring all services for which prior authorization or care management are reviewed according to plan required and approved criteria. 

ESSENTIAL FUNCTIONS:

• Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed.
• Initiate case management referral case set-up for cases referred to case management. Route to appropriate staff when needed.
• Answers phone queues and processes faxes within established standards.
• Updates provider information on authorizations for claims processing
• Data enters authorizations cases in the documentation systems.
• Reviews requests for eligibility and benefits.
• Reviews requests for required documentation and requests required documentation as needed.
• Fully understands policies, procedures, and operations of Zing Health.
• Effectively communicates to management and internal departments timely.
• Receives and responds to all incoming calls from PCPs, specialists, other providers, electronic notification applications, members, authorized representatives, etc. regarding inpatients, surgeries, and outpatient services including DME, Home Health Care and other services requiring a pre-authorization.
• Performs other duties, projects and actions as assigned.
• Interacts with Medical Directors, Pharmacists, Behavioral Health Clinicians, Other Care Management Team Members and Zing internal departments.
• Performs other duties, projects and actions as assigned.

QUALIFICATIONS AND REQUIREMENTS:

• High school diploma or equivalent experience.
• 2+ years of relevant professional experience, UM experience a plus
• Demonstrate effective verbal and written communication skills.
• Demonstrate excellent organizational skills.
• Demonstrate analytic skills when problem solving.
• Proficient in MS Office Applications and ability to learn department and job specific software systems.
• Demonstrate high attention to detail and a high degree of accuracy.
• Able to switch priorities in a positive and effective manner when directed by Company leadership.
• Able to effectively communicate technical concepts with team members and basic business concepts with team members and internal customers.

Preferred Qualifications:

• Knowledge of medical terminology preferred.
• Personal management skills — Plan and manage multiple assignments and tasks, set priorities, and adapt to changing conditions and work assignments. 
• Teamwork —ability to work well with one or more groups.
• Interpersonal effectiveness — Relate to co-workers and build relationships with others in the organization.
• Strong work values — Dependability, honesty, and a positive attitude.