Utilization Management Assistant - Bellaire

 
Position: Utilization Management Assistant - Bellaire

Job ID: 160083

Location: US-TX-Houston

Department: UM ASSISTANTS

Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 9a - 6p, M- F

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.    To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. 

Summary:

We are searching for a Utilization Management Assistant -- someone who works well in a fast-paced setting. In this position, you will receive, process, and complete data entry of demographic information on all referral/authorization requests from participating providers via fax or phone. This role assists and collaborates with all medical management staff, as well as other health plan staff, e.g. Claims Department, Network Development. This role also provides customer service and education for all incoming calls regarding provider and/or product information.

 

Think you’ve got what it takes?



Responsibilities :

  • Serves as support to Medical Management Intake Department
  • Primarily responsible for processing initial incoming faxes or phone requests into the intake department
  • Performs data entry of authorization information into systems, and or fax information to, originating physician and or facility or specialist
  • Responsible for confirming eligibility for requested authorizations and for requesting membership identification numbers for newborns
  • Assists with complaint and appeal process regarding eligibility/claims and documents appropriately in the UM system
  • Assists Member Services and Network Development departments by providing communication and education regarding authorization status and processes and changes
  • Discusses with providers the availability and accessibility of specialists, and assists as necessary, and refers issues to appropriate parties (e.g. QM).
  • Receives transfer calls from member services relating to authorization issues, questions, or capabilities of service providers
  • Assists and educates providers in questions relating submission of detail for SSI authorizations, content, and timeframes necessary for continued stay authorizations


Qualifications:

  • Being fully vaccinated against COVID-19 is required for all employees unless approved for a medical or religious exemption
  • High school diploma or GED required
  • Some college course work preferred
  • 2 years managed care, preferably in medical management department, claims and member service preferred
  • Experience in a healthcare or insurance environment preferred


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