Health Services - Coord, Utilization Mgmt I

Ampcus Inc. • Baltimore, MD

1d • Remote

About The 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.

Requirements

• High School Diploma
• 3 years experience in health care claims/service areas or office support.
• Excellent communication, 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
• Experienced in the use of web-based technology and Microsoft Office applications such as Word, Excel, and PowerPoint, Proficient

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.
• Ability to effectively participate in a multi-disciplinary team including internal and external participants, Proficient

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: Mid Level
• Education Level: High school or GED