Utilization Management Asst

3 weeks ago


Bellaire, United States Texas Children's Health Plan Full time

Job Title: Utilization Management Assistant Job Specialty: Medical Management Job Duration: 13 weeks Shift: Hybrid - Day shift (8:00 am to 5:00 pm or 8:30 am to 5:30 pm or 9:00 am to 6:00 pm) Guaranteed Hours: 40.00 per week Experience: Previous experience in managed care, especially in a medical management department, claims, or member service. Health care setting experience is a plus. License: Not required Certifications: Not required Must-Have: High school diploma or equivalent, excellent customer service skills, and phone etiquette. Ability to operate PC, Windows, Word, fax machine, photocopier, computer, and multi-line telephone.Job Description:- Process initial incoming faxes or phone requests into the intake department.- Gather demographic and benefit data and document it in the appropriate system.- Adhere to time frames and turnaround times, reflected in inter-rater reliability reviews.- Route and evaluate all calls and faxes to assign as necessary to other staff.- Perform data entry of authorization information into systems, fax information to originating physician, facility, or specialist.- Implement nuances of product line and regulatory requirements in processing all authorization requests, including notification requirements.- Confirm eligibility for requested authorizations and request membership identification numbers for newborns.- Utilize resources available from state agencies; references may be made by phone or online.- Assist with the complaint and appeal process regarding eligibility/claims and document appropriately in the utilization management system.- Handle a high volume of calls, prioritize work, be flexible, and perform as a team member.- Apply ICD and CPT coding skills (preferred) and knowledge of medical terminology, ICD 10 & CPT coding, and place of service knowledge.- Previous health plan experience is preferred.- Typing and data entry skills are required.- Customer service experience is preferred.



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