Customer Service Specialist

4 weeks ago


houston, United States Pride Health Full time

Pride Health is hiring a Utilization Management Asst for one of its clients in Houston, TX.


This is a 3+ month contract with a possible extension with competitive pay and benefits.



Job Title- Utilization Management Asst


Location – Houston, TX


Pay range - $20 - $24 per hour on W2.


Length of assignment – 3 months + possible extension


Shift – Hybrid- Day shift 8:00 am to 5 pm or 8:30 to 5:30 pm or 9:00 to 6:00 pm



Job Description


Duties:

• Primarily responsible for processing initial incoming faxes or phone requests into the intake department Gathering

demographic and benefit data and documenting in appropriate system. This is determined through documented policy and

procedures.

• Adheres to time frames, and turn around times, as evidenced by results of inter-rater reliability reviews.

• Routes and evaluates all calls and faxes to refer and assign as necessary to other staff.

• Performs data entry of authorization information into systems, and or fax information to, originating physician and or

facility or specialist.

• Implements nuances of product line and regulatory requirements in the processing of all authorization requests including

notification requirements.

• Responsible for confirming eligibility for requested authorizations and for requesting membership identification numbers

for newborns.

• Utilizes resources available from TCHP or State Agencies. Reference may be made by phone or online. Dates must be

referenced prior to authorizations.

• Assists with complaint and appeal process regarding eligibility/claims and documents appropriately in the UM system.


Skills:

• Managed care, preferably in medical management department, claims and member service background helpful. Health

care setting employment a plus.

• Ability to operate PC, Windows, Word, fax machine, photocopier, computer and multi line telephone.

• Excellent customer service skills and phone etiquette are required.

• Ability to handle high volume of calls, prioritize work, be flexible and perform as member of a team is required.

• ICD and CPT coding skills (preferred)


No, certifications required. Typing and Data Entry is required. Medical Terminology (ICD – 10 & CPT coding, Place of service knowledge is required) Customer Service experience preferred.


Education:

Required- H.S. Diploma or equivalent



Benefits


Pride Global offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.


Equal Opportunity Employer


As a certified minority-owned business, Pride Global and its affiliates - including Russell Tobin, Pride Health, and Pride Now - are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.



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