Utilization Management Coordinator

Cynet Systems • Pearl River, NY

4d • Onsite

About The Position

The Utilization Management Coordinator performs administrative support for members or providers, including benefit verification, authorization creation and management, and claims inquiries. This role involves reviewing authorization requests for initial determination or triaging for clinical review. Additionally, the coordinator provides general support to the department, such as answering calls, managing correspondence, researching information, and problem-solving. A key responsibility includes assisting with reporting, data tracking, and disseminating information related to processes like Continuity of Care and Peer to Peer reviews.

Requirements

• High School Diploma.
• 3 years 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.

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: Mid Level
• Education Level: High school or GED