Utilization Management Representative I

Blue Cross of Idaho•Bozeman, MT

18d•$21 - $29

About The Position

Our Utilization Management Rep will coordinate and manage incoming and outgoing correspondence to include referrals, prior authorizations, provider reconsiderations and other requests for service. Verify provider contracting status and member eligibility to include any applicable pre-existing period. Communicate and coordinate with providers to obtain and verify information related to such requests. We're looking for Utilization Management Rep with: 2 years’ relevant experience What a day of a Utilization Management Rep would look like: Review’s member eligibility and benefit structure for requested referrals or prior authorizations. Responds to incoming calls from internal and external customers via multiple types of media. Review documentation and requests additional information needed to complete review of requested services. Initializes, routes, and complete, as appropriate, request for services. Informs members and providers of determination. Enters and maintains documentation per policy and procedures. Completes correspondence according to established workflows. Performs other duties and responsibilities as assigned.

Requirements

2 years’ relevant experience
Good verbal and written communication skills
Medical terminology
Familiar with ICD10 and CPT coding
Problem Solving

Responsibilities

Coordinate and manage incoming and outgoing correspondence to include referrals, prior authorizations, provider reconsiderations and other requests for service.
Verify provider contracting status and member eligibility to include any applicable pre-existing period.
Communicate and coordinate with providers to obtain and verify information related to such requests.
Review’s member eligibility and benefit structure for requested referrals or prior authorizations.
Responds to incoming calls from internal and external customers via multiple types of media.
Review documentation and requests additional information needed to complete review of requested services.
Initializes, routes, and complete, as appropriate, request for services.
Informs members and providers of determination.
Enters and maintains documentation per policy and procedures.
Completes correspondence according to established workflows.
Performs other duties and responsibilities as assigned.