Health Services - Coord, Utilization Mgmt I

Ampcus Inc. • Reston, VA

1d • Remote

About The Position

Ampcus Inc. is seeking a motivated candidate for the role of Utilization Management Coordinator I. This position 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. The role involves performing member or provider-related administrative support, reviewing authorization requests, providing general support and coordination services, and assisting with reporting and data tracking.

Requirements

• Overall 3 years of experience in utilization management.
• CPT and ICD-10 coding (2 years of experience).
• Medical management coordination.
• Government programs for Medicare and Medicaid.
• Handling faxes and incoming phone calls.
• Authorization experience.
• High School Diploma
• 3 years of experience in health care claims/service areas or office support.
• Ability to effectively participate in a multi-disciplinary team including 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, consistently demonstrating tact and diplomacy.
• Ability to pay attention to the minute details of a project or task.
• Experienced in the use of web-based technology and Microsoft Office applications such as Word, Excel, and PowerPoint.
• The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs.
• Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
• Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Nice To Haves

• Experience with Medicare/Medicaid is preferred.
• Call center experience is preferred.
• 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
• Career Level: Entry Level
• Education Level: High school or GED