Healthcare Management Associate
3 weeks ago
Job Responsibilities
">We are seeking a highly skilled professional to join our team as a Medical Professional Specialist. In this role, you will be responsible for:
">- ">
- Evaluating and interpreting clinical review requests to ensure compliance with accreditation and governmental regulations;">
- Communicating effectively with provider offices to clarify procedures and requirements;">
- Applying internal policies, contractual provisions, and regulatory requirements to validate member eligibility and benefit information;">
- Maintaining accurate electronic records within our Utilization Management system;">
- Collaborating with vendors to resolve authorization issues and update claims processing accordingly.">
Duties
">In addition to the above responsibilities, you will also be responsible for:
">- ">
- Triaging and distributing clinical review requests to respective teams based on type of service, place of treatment, provider relationship, and line of business;">
- Notifying and communicating issues associated with authorization files with unit coordinators, supervisors, or UM Solutions Administrators;">
- Escalating calls as appropriate, taking into account urgency, customer level of concern, and required knowledge to respond accurately.">
Requirements
">To be successful in this position, you will need:
">- ">
- An Associate's degree or equivalent combination of education and work experience;">
- Excellent customer service skills and verbal communication abilities;">
- Working knowledge of basic office equipment and Microsoft Office applications;">
- Familiarity with CPT/HCPCS coding and medical terminology.">
Estimated Salary
">$70,000 - $90,000 per year, based on location and experience.
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