Healthcare Utilization Coordinator

4 weeks ago


Baltimore, Maryland, United States Three Point Solutions Full time
Job Description

Job Title: Healthcare Utilization Coordinator

Job Summary:

We are seeking a skilled Healthcare Utilization Coordinator to join our team at Three Point Solutions. As a key member of our healthcare team, you will play a vital role in supporting our clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination, and quality of care.

Key Responsibilities:

  • Administrative Support: Perform member or provider-related administrative support, including benefit verification, authorization creation and management, claims inquiries, and case documentation.
  • Authorization Review: Review authorization requests for initial determination and/or triage for clinical review and resolution.
  • General Support: Provide general support and coordination services for the department, including answering and responding to telephone calls, taking messages, letters, and correspondence, researching information, and assisting in solving problems.
  • Reporting and Data Analysis: Assist with reporting, data tracking, gathering, organization, and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.

Requirements:

To be successful in this role, you will need:

  • Education: High School Diploma
  • Experience: 3 years of experience in healthcare claims/service areas or office support
  • Preferred Qualifications: Two years of experience in a healthcare/managed care setting or previous work experience within the division, knowledge of CPT and ICD-10 coding

Skills and Abilities:

  • Communication and Organizational Skills: Excellent communication, organizational, and customer service skills
  • Medical Terminology: Knowledge of basic medical terminology and concepts used in managed care
  • Technical Skills: Experienced in the use of web-based technology and Microsoft Office applications such as Word, Excel, and PowerPoint

Additional Information:

This is a challenging and rewarding role that requires strong analytical and problem-solving skills, as well as excellent communication and interpersonal skills. If you are a motivated and detail-oriented individual who is passionate about delivering exceptional customer service, we encourage you to apply.

Top 5 Required Skills:

  • Medical Background:
  • Computer Skills:
  • Medical Terminology:
  • Claims and Service Office Support:
  • CPT and ICD-10 Coding:


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