Utilization Management Intake Representative II

2 days ago

Albany, New York, United States Monroe Plan for Medical Care Full time
Job Title: Utilization Management Intake Representative II

We are seeking a highly skilled and compassionate Utilization Management Intake Representative II to join our team at Monroe Plan for Medical Care. As a key member of our Utilization Management team, you will play a critical role in ensuring that our members receive the best possible care while navigating the healthcare system.

Job Summary:

The UM Intake Representative II provides and processes information to Monroe Plan's contracted customers, business associates, and participating providers to successfully resolve their telephone, email, and fax inquiries. Inquiries include eligibility, referrals, and claims.

Key Responsibilities:
  • Respond to incoming queries from Monroe Plan's contracted customers, business associates, and participating providers in accordance with Medicaid, corporate service strategy, and legislative requirements.
  • Demonstrate a thorough understanding of contract benefits, enrollment processes, and referrals as they relate to insurance eligibility.
  • Utilize appropriate resource materials to effectively and accurately interpret, respond, and resolve customer inquiries and concerns.
  • Ability to independently handle and resolve incoming claims calls from providers.
Requirements:
  • 9 months satisfactory performance as UM Intake Rep I or equivalent experience.
  • Successful completion of CSP Level II training class.
  • Satisfactory performance for 90 days taking Level II calls.
  • Must meet minimum performance requirements for position during the final 30 days of review period.
  • Must successfully meet other performance metrics as specified.
  • High school diploma or equivalent.
  • 2 years of experience in a customer call center service position.
  • Effective and diplomatic oral communication skills. Good listening skills.
  • Sound reasoning and problem-solving skills.
  • Strong computer skills.
  • Ability to read, understand, and follow written policies and procedures.
  • Ability to learn new skills.
  • Demonstrates cultural competence.
Preferred Qualifications:
  • Experience in the insurance industry. Managed Medicaid experience a plus.
  • College-level experience preferred; an Associate's degree or beyond a plus.
Benefits:
  • 401(k)
  • Dental insurance
  • Disability insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance
Work Schedule:
  • 8 hour shift
  • Day shift
  • Monday to Friday
Work Location:

Remote

Monroe Plan for Medical Care is an Equal Opportunity Employer.

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