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Utilization Management Specialist

3 months ago

Meridian, Idaho, United States Blue Cross of Idaho Health Service, Inc. Full time

Our Utilization Management Rep will coordinate and manage incoming and outgoing correspondence to include referrals, prior authorizations, provider reconsiderations and other requests for service. Verify provider contracting status and member eligibility to include any applicable pre-existing period. Communicate and coordinate with providers to obtain and verify information related to such requests.

We're looking for Utilization Management Rep with:

  • 2 years' relevant experience
What a day of a Utilization Management Rep would look like:
  • Review's member eligibility and benefit structure for requested referrals or prior authorizations.
  • Responds to incoming calls from internal and external customers via multiple types of media.
  • Review documentation and requests additional information needed to complete review of requested services.
  • Initializes, routes, and complete, as appropriate, request for services. Informs members and providers of determination.
  • Enters and maintains documentation per policy and procedures.
  • Completes correspondence according to established workflows.
  • Performs other duties and responsibilities as assigned.
Additional skills that we are looking for:
  • Good verbal and written communication skills
  • Medical terminology
  • Familiar with ICD10 and CPT coding
  • Problem Solving
Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.