About the Role:
The role of a Utilization Management Support Specialist is to assist the 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 tasks 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, letters and correspondence, researching information, and assisting in problem-solving.

• Assist with reporting, data tracking, gathering, organization, and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.

Education Qualification:

• High School Diploma required

Required Skills:

• 3 years of experience in healthcare claims/service areas or office support

• 2 years of experience in a healthcare/managed care setting or prior work experience within the division

• 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

• Knowledge of standardized processes and procedures for evaluating medical support operations business practices

• Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy

• Ability to pay attention to the minute details of a project or task

• Must work effectively in a fast-paced environment with changing priorities and deadlines

• Must be able to meet established deadlines and handle multiple customer service demands

• Must provide positive customer service to internal and external customers, including challenging customers

Pay Range:
$17.00 – $20.00 per hour