3 years experience in health care claims/service areas or office support
Two years’ experience in health care/managed care setting
Knowledge of CPT and ICD-10 coding
Requirements:
Supports the Utilization Management clinical teams with non-clinical administrative tasks.
Performs member or provider related administrative support including benefit verification and authorization management.
Reviews authorization requests for initial determination and/or triages for clinical review.
Provides general support and coordination services for the department.
Job description
Our client, is a Health Insurance company, is looking for a Coord, Utilization Mgmt I for their Remote location.
Responsibilities:
Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality of care.
35% Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims inquiries and case documentation.
35% Reviews authorization requests for initial determination and/or triages for clinical review and resolution.
20% Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
10% Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.
Requirements:
High School Diploma
3 years experience in health care claims/service areas or office support.
Two years’ experience in health care/managed care setting or previous work experience within division
Knowledge of CPT and ICD-10 coding.
Knowledge, Skills and Abilities (KSAs)
Ability to effectively participate in a multi-disciplinary team including internal and external participants., Proficient
Excellent communication, organizational and customer service skills. , Proficient
Knowledge of basic medical terminology and concepts used in managed care., Proficient
Knowledge of standardized processes and procedures for evaluating medical support operations business practices., Proficient
Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy. , Proficient
Ability to pay attention to the minute details of a project or task, Proficient
Experienced in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point, Proficient
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Client care programs.
Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Top 5 Required Skills Communication, data entry, medical terminology, medical knowledge, ability to multi-task
