Health Services - Coord, Utilization Mgmt I

Talteam Inc. • Baltimore, MD

11h

About The Position

The Medical Management Coordinator supports Utilization Management clinical teams by performing non-clinical administrative tasks related to pre-service, utilization review, care coordination, and quality of care. The role provides administrative support to members and providers, including benefit verification, authorization creation and management, claims inquiries, and case documentation. It also reviews authorization requests for initial determination or triages them for clinical review and resolution.

The coordinator provides general departmental support, including responding to telephone calls, taking messages, preparing letters and correspondence, researching information, and helping resolve problems. The role also assists with reporting, data tracking, and gathering, organizing, and sharing information, including for the Continuity of Care process and Peer to Peer review tracking.

Requirements

• High school diploma.
• Three years of experience in health care claims/service areas or office support.
• Ability to participate effectively in a multidisciplinary team with internal and external participants.
• Excellent communication, organizational, and customer service skills.
• Knowledge of basic medical terminology and concepts used in managed care.
• Knowledge of standardized processes and procedures for evaluating medical support operations business practices.
• Excellent independent judgment and decision-making skills, with tact and diplomacy.
• Attention to detail.
• Experience using web-based technology and Microsoft Office applications, including Word, Excel, and PowerPoint.

Nice To Haves

• Two years of experience in a health care or managed care setting, or previous work experience within the division.
• Knowledge of CPT and ICD-10 coding.
• Additional skills or systems: PCMR, CAU, On site Mailing Canton Office, Provider Relations, Guiding Care, SharePoint, and claims adjustment.

Responsibilities

• Provide administrative support for members and providers, including benefit verification, authorization creation and management, claims inquiries, and case documentation.
• Review authorization requests for initial determination and/or triage them for clinical review and resolution.
• Answer and respond to telephone calls, take messages, prepare letters and correspondence, research information, and assist with problem solving.
• Provide general support and coordination services for the department.
• Assist with reporting and data tracking, and gather, organize, and disseminate information, including Continuity of Care process information and Peer to Peer review tracking.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED