Department Specialist III
Element Care•Lynn, MA
•Onsite
About The Position
The UM Support Specialist is a well-organized, team player who supports the SCO UM Department by creating and reviewing service authorizations for enrolled members. This is a full-time position, Monday- Friday 8-4 position; no nights, weekends or holidays!
Requirements
- High school diploma or equivalent.
- Previous (3-5 years) administrative or related experience required.
- Must be able to resolve issues, collaborate with a team, and understand the need for accurate and timely communication and escalation.
- Working knowledge of, or proficient in, Microsoft office applications, and quick-to-learn proprietary software packages.
- Ability to interact with all levels of internal and external personnel.
- Strong written and verbal communication skills.
- Strong organizational skills, with attention to detail.
- Strong customer service skills.
- Practice knowledge of HIPAA policies and guidelines.
- Proof of Covid vaccine
Responsibilities
- Perform quality review of member service authorizations.
- Perform outreach to internal and external partners to obtain outstanding documentation to prepare authorizations for clinical review.
- Prioritize work based upon Service Decision timeframes (Standard vs Expedited)
- Apply regulatory guidelines to determine member qualification for decisoning of authorizations.
- Follow established protocols and compliance standards to ensure regulatory requirements are met.
- Manage Centralized Electronic Record work queue for authorization assignment.
- Serves as Subject Matter Expert concerning the UM department’s policies and procedures.
- In supervisors’ absence, ensures that all departmental matters are handled appropriately.
- Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
- Required to complete annual Inter-Rater Reliability testing to decision member authorizations.
- Provide back-up support to other areas.
- Provide training to other non-exempt personnel.
- Performs other duties as required.
Benefits
- Health insurance
- Dental insurance
- Vision insurance
- Paid time off
- Retirement plan
- Supplemental benefits
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
