Utilization Management Client Services Specialist

2 weeks ago


La Puente, California, United States Innovative Management Systems, Inc. Full time

Position Type:

Full-time

Overview:

The Utilization Management Client Services Specialist is essential in ensuring the satisfaction of our clients and members by providing exceptional support and addressing any inquiries or challenges related to utilization management submissions or procedures. This role will also actively assist the Utilization Management Department and offer comprehensive support, including administrative and clerical tasks such as data entry, mailing, and other assigned duties. A solid understanding of utilization management processes and familiarity with the company's database system is crucial for effectively assisting both internal and external stakeholders with their claims-related needs. Success in this position relies on strong customer service, communication, and problem-solving abilities. Additionally, attention to detail, adaptability, empathy, and relevant data entry experience are vital for providing support to the Utilization Management team and external stakeholders.

Key Specifications:

  • Non-Exempt
  • Full-Time
  • In-Office
  • Monday - Friday
  • Compensation Range: $20 - $25, based on experience

We are an Equal Opportunity Employer and value diversity in our workforce. We are also an E-Verify Employer.

Primary Responsibilities:

• Respond to inquiries via phone and email from both external and internal stakeholders regarding utilization management issues, authorizations, and referrals.

• Generate new tickets in the database/software systems for every incoming inquiry, tracking the issue from start to resolution.

• Conduct follow-up communications for any missed messages, calls, or emails.

• Support the Utilization Management Department in claims submissions and processes.

• Ensure quality and accuracy of information entered into databases and software systems.

• Investigate database tickets and input clear, concise, and quality notes into the software/database systems.

• Assist in generating reports related to authorizations as needed.

• Ensure all tickets are resolved and responded to appropriately.

• Provide assistance in data entry and other support tasks within the Utilization Management Department as assigned by supervisors.

• Collaborate with internal teams to determine the status of utilization management authorizations/referrals and resolve any issues.

• Communicate clearly and conduct outreach as necessary to resolve utilization management inquiries.

• Create and/or run reports as required by other internal staff.

• Undertake additional projects as assigned.

About Innovative Management Systems, Inc.:

At Innovative Management Systems, Inc., we are seeking highly motivated and resourceful individuals to join our expanding team. Our mission is to innovate the healthcare sector by providing management and consulting services to healthcare entities, including facilities, medical groups, providers, and suppliers. With our extensive experience and comprehensive knowledge of the healthcare industry, we are dedicated to delivering quality services and customer care to our clients and their Medicare beneficiaries. By joining our team, you will gain valuable insights into the managed care industry and contribute to the professional growth of our organization. We encourage you to take initiative and ownership of your projects to make a meaningful impact.

Qualifications:

Education:
• High School Diploma or GED; or equivalent experience in IPA, MSO, or Health Plan.

Experience:
• Required experience in MSO, IPA, and/or Health Plan.
• Understanding of MSO operations and processes is essential.
• Customer service experience is mandatory.
• Experience in a fast-paced environment with the ability to adapt and be flexible is necessary.
• Familiarity with QuickCap and/or EZ-Cap is required.
• Proven experience in accurate data entry and usage of QuickCap and/or EZ-Cap.

Skills/Knowledge/Abilities:
• Strong problem-resolution and attention-to-detail skills are essential.
• Proficient data entry skills; computer and technological proficiency are required.
• Ability to learn quickly in a dynamic administrative environment and handle calls efficiently.
• Capability to continuously audit data as needed.
• Familiarity with MSO reporting requirements.
• Excellent customer service and communication skills.
• Strong conflict resolution and problem-solving abilities are necessary.
• Ability to manage multiple tasks and prioritize effectively.

* Please note that the responsibilities outlined above are summarized and may not encompass all tasks associated with the position. The nature of the role may require adaptation to changing circumstances and additional responsibilities not explicitly mentioned here. The organization reserves the right to modify, interpret, or supplement the job duties as needed.



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