Utilization Management Asst

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?

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

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 authorizationsf demographic information on all referral/authorization requests from participating providers via fax or phone. Assists and collaborates with all medical management staff, as well as other health plan staff, e.g. Claims Department, Network Development. Provides customer service and education for all incoming calls regarding provider and/or product information.

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