Healthcare Management Associate

3 weeks ago


Kapolei, Hawaii, United States Hawaii Medical Service Association Full time

Job Responsibilities

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We are seeking a highly skilled professional to join our team as a Medical Professional Specialist. In this role, you will be responsible for:

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  • 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.">
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Duties

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In addition to the above responsibilities, you will also be responsible for:

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  • 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.">
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Requirements

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To be successful in this position, you will need:

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  • 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.">
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Estimated Salary

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$70,000 - $90,000 per year, based on location and experience.



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