Utilization Management Coordinator I

Ampcus • Reston, VA

8d • Remote

About The Position

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.
Job Title: Utilization Management Coordinator - I.
Location: Reston, VA.
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.

Requirements

• Previous authorization experience.
• Strong analytical skills.
• Goodmunication skills.
• Electronic efficiency.
• Reliability/Dependability.
• Ability to effectively participate in a multi-disciplinary team including internal and external participants., Proficient.
• Excellentmunication, organizational and customer service skills., Proficient.
• Knowledge of basic medical terminology and concepts used in managed care., Proficient.
• Knowledge of standardized processes and procedures for evaluating medical support operations business practices. Proficient.
• Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy., Proficient.
• Ability to pay attention to the minute details of a project or task, Proficient.
• Experience in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point, Proficient.
• High School Diploma.
• 3 years' experience in health care claims/service areas or office support.

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
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees