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comprising the Utilization Management (UM) program. Incumbent must be proficient in all UM processes such as pre-authorizations, claim reviews, triage and case assignments.Requirements
EDUCATION & EXPERIENCE
Associate's degree in related field with one (1) year operations experience (health insurance industry preferred). OR minimum three (3) years' operations experience (health insurance industry preferred).
ESSENTIAL SKILLS & ABILITIES
Customer Service
Personal Computer (PC) Software
Data Entry
Time Management
Professional Etiquette
Multitasking
Logical Thinking
Oral & Written Communication
Strong Interpersonal Skills
Analyze Information
Highly Organized
Detail Oriented
Highly Motivated Self-Starter
Proficiency with MS Office Suite (Word, Excel, PowerPoint including web-based computer applications required).
Ability to work independently or as a team.
SkillsCustomer Service, Data Entry, Detail-Oriented, Interpersonal, Logical Thinking, Microsoft Office (Word, Outlook, Excel, PowerPoint), Multitasking, Oral and Written Communication Skills, Organized, Professional Etiquette, Self-Starter, Time ManagementResponsibilitiesConducts or supports UM system testing (as needed)., Maintains understanding of role specific regulatory requirements pertaining to UM Processes and operations., Performs other duties as assigned., Processes practitioner pre-authorization requests while adhering to administrative guidelines, policies and procedures., Processes prior authorization requests which include collecting and transferring non-clinical data and acquiring clinical data while adhering to administrative guidelines., Supports departmental initiatives such as policy/procedure review, audit preparation, and work instruction updates.CertificationsSecurity RequirementsThis position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of DutiesSegregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment TypeRegularADA Requirements
1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.