Health Services - Coord, Utilization Mgmt I

TalTeam • Baltimore, MD

9d • Onsite

About The Position

PURPOSE:
Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality of care.

ESSENTIAL FUNCTIONS:
35% Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims inquiries and case documentation.

35% Reviews authorization requests for initial determination and/or triages for clinical review and resolution.

20% Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.

10% Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.

Requirements

• High School Diploma
• 3 years experience in health care claims/service areas or office support.
• Previous authorization experience
• Strong analytical skills
• Good communication skills
• Electronic efficiency
• Reliability/Dependability

Nice To Haves

• Two years' experience in health care/managed care setting or previous work experience within division
• Knowledge of CPT and ICD-10 coding.

Responsibilities

• Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims inquiries and case documentation.
• Reviews authorization requests for initial determination and/or triages for clinical review and resolution.
• Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
• Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 101-250 employees