Healthcare Support Specialist

3 weeks ago

Nashville, Tennessee, United States Staffing Now Full time
Job Summary

We are seeking a highly skilled and detail-oriented Utilization Management Representative to join our team at SNI Companies. As a key member of our healthcare support team, you will play a critical role in coordinating cases for precertification and prior authorization review.

Key Responsibilities
  • Manage incoming calls and post-service claims work, ensuring timely and accurate processing.
  • Determine contract and benefit eligibility, providing authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests.
  • Refer cases requiring clinical review to a Nurse reviewer, ensuring seamless coordination.
  • Identify and data-enter referral requests into the UM system, adhering to plan certificate guidelines.
  • Respond to telephone and written inquiries from clients, providers, and in-house departments, providing exceptional customer service.
  • Conduct clinical screening processes, authorizing initial sessions with providers.
  • Check benefits for facility-based treatment, ensuring accurate and efficient processing.
  • Develop and maintain positive customer relationships, coordinating with various functions to ensure timely and effective resolution of customer requests.
Requirements

To be successful in this role, you will need:

  • A high school diploma or equivalent.
  • At least one year of customer service or call-center experience.
  • Proficient analytical, written, and oral communication skills.
  • Medical terminology training and experience in the medical or insurance field are preferred.

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