Utilization Management Administrative Support
About The Position
The Utilization Management Administrative Support role is crucial in assisting various departmental functions. This position ensures that email requests from provider offices are handled promptly and efficiently. Responsibilities include collecting missing information from offices necessary for claims processing and assisting in the creation of correspondence for providers and members. As well as including documentation to the requests for the clinical processors to make appropriate decisions. This role is integral in driving the workflow and efficiency of the entire department. The UM (Utilization Management) Department supports our clients and company through utilizing clinical criteria to approve or deny a service based on the authorization. The UM department plays a crucial role in ensuring that healthcare services provided to members are appropriate, efficient, and effective. They achieve this by utilizing clinical criteria and evidence-based guidelines to evaluate the necessity and appropriateness of treatments. In the Utilization Management Administrative Support role, detail matters and you will assist in data entry, and communication required by Utilization Management Department involving correspondence for enrollees and providers. You will ensure that entry and manual creation of these ad hoc notifications are completed in a timely manner and meets federal, state, NCQA or contractual requirements.
Requirements
- High School Diploma or GED is required.
- Proficiency in accurate data entry, with minimal to no errors.
- Exceptional reading and writing with the ability to communicate at a professional level appropriately at all levels of the organization.
- Strong organizational and time-management skills, with the ability to manage multiple tasks and priorities effectively.
- Ability to think analytically and make independent decisions.
- Ability to meet or exceed quality, accuracy, and production standards as determined by Avēsis.
- A reliable internet connection (25 MBPS upload/50 MBPS download speed) and an appropriate workspace are essential for success in this remote role.
Nice To Haves
- Previous Administrative Support experience.
- High level of accuracy and attention to detail in all aspects of work.
- Strong interpersonal skills, with the ability to work well both independently and as part of a team.
- Flexibility and adaptability to handle changing priorities and tasks.
- Ability to handle sensitive information with discretion and maintain confidentiality
- Proficient with Microsoft applications, SharePoint technology, Teams, and Outlook.
Responsibilities
- Perform outreach to providers for correction and resubmission if a request is submitted with insufficient information.
- Create ad-hoc manual letter requests utilized to communicate with an enrollee and/or provider. These communications are time sensitive and must meet regulatory, accreditation or contractual requirements.
- Handle clerical support for the department, including but not limited to receipt and response of incoming and outgoing fax, email transmissions both internal and external, draft/upkeep meeting agendas, meeting minutes.
- Support UM leadership and Avēsis’ communication team in the review and routine maintenance of letter template library for accuracy.
- Light travel and delivery to local post office to ensure same day mailing for urgent mailings.
- Other duties as assigned.
- Ability to operate in a fast-paced environment under tight deadlines.
- Ability to multi-task.
- Handle outgoing correspondence, including emails, phone calls, and mail.
- Draft and proofread documents.
- Organize and maintain digital files and records, ensuring they are easily accessible and up to date.
- Assist with special projects and tasks as assigned, ensuring they are completed on time and to a high standard.
Benefits
- Competitive compensation package.
- Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
- Life and disability insurance.
- A great 401(k) with company match.
- Tuition assistance, paid parental leave and backup family care.
- Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
- Employee Resource Groups that advocate for inclusion and diversity in all that we do.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
