Utilization Management Intake Specialist

2 months ago

Houston, United States Ethos Risk Services Full time
ABOUT US

Ethos Risk Services is a leading insurance claims investigation and medical management company committed to providing better data that translates into better decision-making for our clients. We are at the forefront of innovation in our space, and our success is driven by a dynamic team passionate about delivering exceptional services to our customers.

JOB SUMMARY

Our Ethos Risk team is seeking a full-time Utilization Management (UM) Intake Specialist (REMOTE) to play a crucial role in handling and coordinating the administrative functions of the utilization review process. This is a non-clinical position and does not involve the interpretation of clinical information. The UM Intake Specialist works under the oversight of Utilization Management Nurses and the UM Team Supervisor.

KEY RESPONSOBILITIES:
  • Mail, Fax, and Call Management: Receive, screen, and manage incoming communications.
  • Service Request Review: Ensure service requests are complete and accurate.
  • Data Entry: Collect and input structured clinical data (e.g., diagnosis codes, procedure codes) and demographic information into the Ethos Utilization Management System.
  • Review Assignment: Assign reviews to the Utilization Management Nurse.
  • Communication: Assist with drafting determination letters and sending communications via fax, email, or mail under the direction of the Utilization Management Nurse.
  • Customer Service: Provide excellent customer service to clients and stakeholders.
  • Compliance: Adhere to Ethos Policies and Procedures and URAC standards.
  • Quality Management: Support the objectives of the Quality Management Program.
  • Confidentiality: Maintain confidentiality and security in all aspects of performance.
  • Additional Duties: Perform other related duties as required.

QUALIFICATIONS

Education:
  • Required: High school diploma or equivalent.
  • Preferred: Associate's degree or higher.

Skills:
  • Strong customer service abilities.
  • Excellent oral and written communication skills.
  • Proficiency in Microsoft Office products.
  • Ability to work effectively as part of a team.
  • Strong organizational skills.
  • Excellent interpersonal skills.
  • Ability to maintain discretion and confidentiality.
  • Capability to multitask efficiently.

Experience:
  • Minimum of 1 year of administrative or customer service-related experience, or an equivalent combination of training, education, and experience.
  • Experience with CPT/ICD-10 coding is preferred.

Certifications:
  • No licensure or certification is required.
  • Certification in medical coding or medical terminology is preferred.

WORKING CONDITIONS
  • Work environment is indoors, either in an office setting or a home office.
  • Prolonged periods of sitting and typing, with intermittent breaks, for up to 8 hours per day.
  • Regular use of a computer monitor, telephone, instant messaging software, and email communication.

Location: Remote

Employment Type: Full-Time, Hourly

Pay Range: $15-$20/hr

Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic protected by law.

A background check will be conducted, in accordance to the local state law and regulations.

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