About the Role:

• We are seeking a Utilization Management Support Specialist to assist our clinical teams with non-clinical administrative tasks related to pre-service, utilization review, care coordination, and quality of care.

Responsibilities:

• Perform member or provider related administrative support such as benefit verification, authorization creation and management, claims inquiries, and case documentation.
• Review authorization requests for initial determination and/or triage for clinical review and resolution.
• Provide general support and coordination services for the department including answering and responding to telephone calls, taking messages, and assisting in problem-solving.
• Assist with reporting, data tracking, gathering, organization, and dissemination of information related to Continuity of Care process and tracking of Peer to Peer reviews.

Education Qualification:

• High School Diploma

Required Skills:

• 3 years of experience in health care claims/service areas or office support.
• Knowledge of CPT and ICD-10 coding.
• Ability to effectively participate in a multi-disciplinary team.
• Excellent communication, organizational, and customer service skills.
• Knowledge of basic medical terminology and concepts used in managed care.
• Proficiency in using web-based technology.
• Ability to work in a fast-paced environment with changing priorities and deadlines.
• Strong attention to detail and ability to meet established deadlines.
• Ability to provide positive customer service to internal and external customers.

Pay Range:
 $20-$23/hr.