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Utilization Management Specialist II
2 months ago
Company Background
At Altais Health Solutions, we are on a mission to transform healthcare experiences and enhance the healthcare system for providers, patients, and the clinical community. Our innovative approach focuses on developing advanced clinical support tools, technology, and services that empower healthcare professionals to prioritize patient care. We invite you to become part of our dedicated team as we strive to redefine the future of healthcare.
Team Dynamics
Join our dynamic Healthcare Management Prior Authorization team, comprised of over 4,000 physicians across multiple locations, dedicated to serving a diverse patient population. If you are enthusiastic about innovating healthcare and wish to contribute to a mission-driven organization that values fresh ideas, we would love to connect with you.
Role Responsibilities
As a Utilization Management Specialist II, you will play a vital role in fostering a culture of respect and ethical practices within our team. Your responsibilities will include ensuring compliance with regulatory standards and maintaining timely responses to authorization requests.
Your collaboration with various teams, including Ambulatory and Concurrent Care, Network Management, Quality Improvement, and Practice Success, will be essential. Key duties include:
- Managing all incoming authorization requests through designated portals, ensuring eligibility verification and data entry are completed accurately and within established timelines.
- Serving as the primary liaison for internal and external stakeholders seeking assistance with authorization inquiries.
- Conducting reviews of authorization requests based on established criteria.
- Assisting in the preparation of denial correspondence under the guidance of professional staff, ensuring accurate information is communicated to provider offices and internal teams.
- Engaging with provider offices to obtain necessary clinical documentation for medical reviews.
- Participating in cross-training initiatives to ensure comprehensive knowledge of all UM processes.
- Upholding strict confidentiality of health records and adhering to HIPAA regulations.
Qualifications and Skills
- 2-3 years of experience with Microsoft Office applications is required.
- Strong verbal and written communication skills, along with organizational and analytical capabilities, are essential.
- Ability to exercise independent judgment and initiative is necessary.
- Excellent telephone communication skills are required.
- Team collaboration and the ability to manage multiple tasks effectively are important.
- A motivated individual who approaches work with enthusiasm and professionalism is desired.
- Compliance with organizational policies and procedures is expected.
- Maintaining confidentiality of client information and ensuring privacy is paramount.
- A high school diploma or equivalent experience in medical terminology, CPT, HCPCS, and ICD coding is required.
- Two years of prior experience in utilization management, medical records, billing, or medical office settings is preferred.
Alignment with Our Values
- You are committed to enhancing the healthcare experience and resonate with the mission of Altais.
- You demonstrate boldness and curiosity, embracing new challenges and creative solutions.
- You take pride in your work and hold yourself and others to high standards of accountability.
- You exhibit compassion and emotional intelligence in your interactions, making thoughtful decisions.
- You believe in collaboration and recognize the value of diverse perspectives in achieving common goals.
- You build trust with colleagues and clients through honesty and transparency.
At Altais, we value the unique contributions of each team member. Compensation for this role will be determined based on various factors, including education and experience. We offer a competitive salary and a comprehensive benefits package tailored to meet your needs.
We are committed to protecting the privacy and security of personal information provided during the application process. Please refer to our privacy notice for details on how we handle your information.
Physical Requirements: This role involves a combination of office and remote work, primarily sedentary in nature.
All external candidates must successfully complete a background check and drug screening as part of the hiring process. We are an equal opportunity employer and welcome applicants from diverse backgrounds.
