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Utilization Management Specialist

3 months ago

Sun Prairie, United States LSM Chiropractic Full time

**Are you looking for a position in the Health/Wellness field and have an interest and passion for chiropractic care and services, and want to work for a reputable, established Chiropractic Clinic that is growing rapidly and offers a great work environment for its employees?**
- We at LSM Chiropractic are fueled by the energy of our team. We promote a culture where team members take initiative in job performance, problem solving and in setting and achieving goals. While we insist on respect for patients and fellow team members, we also encourage an environment full of camaraderie and laughter. We strive to inspire our patients and our team members to live a healthy life._
- **We were voted Capitol Newspaper/Wisconsin State Journal Top Places to Work 2018, 2020, 2021, 2022, 2023 & 2024 and Madison Magazine Best Places to Work 2019**_
- To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodation may be made to enable an individual with disabilities to perform the essential job responsibilities._

**LSM Values**:We at LSM Chiropractic are fueled by the energy of our team. We promote a culture where team members take initiative in job performance, problem solving and in setting and achieving goals.

While we insist on respect for patients and fellow team members, we also encourage an environment full of camaraderie and laughter. We strive to inspire our patients and our team members to live a healthy life.

**General Description**:The primary responsibility of this position is to perform the insurance and prior authorization functions of the Revenue Cycle Department ensuring accurate coverage information is entered for billing processing.

**Essential Job Responsibilities**:
**Patient Support**: Provide insurance and billing information to patients and other LSM employees. This may involve explaining LSM policies, insurance procedures, and offering other support as needed.

Identify and verify patient benefits for the clinics and post benefit information to the patient’s account in the database, as well as communicate the information to the appropriate clinic as necessary.

**Prior Authorization and Utilization Review**: Submit timely prior authorization requests, review utilization and service counts of service requests, and coordinate with front office clinic staff to support required medical records requests from patients.

**Billing Task Support**: Support the review of patient and insurance payment review as related to insurance coverage denials and other coverage related payment needs.

**Confidentiality**: Display a high level of integrity by maintaining confidence of proprietary information. Protect all tangible and intangible company assets including proprietary software and databases.

**Additional Job Responsibilities**:

- Review outgoing medical records for accuracy.
- Conduct special projects as assigned.

**Required Skills and Competencies**:

- High School diploma or equivalent
- 1-2 years experience in healthcare setting
- Working knowledge of health insurance information and portals
- Excellent verbal and written communication skills
- Strong customer service skills and attention to detail

Pay: $16.50 per hour

Expected hours: 40 per week

**Benefits**:

- 401(k)
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance

Schedule:

- Monday to Friday

People with a criminal record are encouraged to apply

**Education**:

- High school or equivalent (required)

**Experience**:

- Medical billing: 1 year (preferred)
- Customer service: 1 year (preferred)
- Insurance verification: 1 year (preferred)
- Healthcare setting: 1 year (required)
- Credentialing: 1 year (preferred)

Work Location: In person