Utilization Management Services Rep I

Excellus BCBS•Rochester, NY

3d•Hybrid

About The Position

This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers through completing timely and accurate inbound and/or outbound calls, creating authorizations via phone, Care Advance Provider Tool, and fax for inpatient and outpatient procedures, behavioral health, and durable medical equipment.

Requirements

High School Diploma or GED.
Experience with using a desktop computer in a professional environment, preferably with Microsoft Office Products.
Strong analytical and problem-solving skills.
Strong written and verbal communication skills and ability to work within a team.
Demonstrated organizational skills to manage multiple projects and priorities.
Self-motivated and able to work independently, as well as on intra- and inter-departmental teams where needed.

Nice To Haves

Call center experience preferred, not required.

Responsibilities

Facilitates inbound and outbound calls to customers (members and providers) by delivering excellent customer-centered service providing information regarding services in a call center environment.
Responds to customers in a professional, efficient manner to encourage public acceptance of products, services, and policies.
Perform triage for UM Services.
Serves as the primary contact for providers regarding authorization requests.
Contacts members and providers concerning regulatory requirements relating to Department of Health (DOH) notifications and other regulatory requirements such as the National Committee for Quality Assurance (NCQA) guidelines.
Provides timely response to all research inquiries from other departments and assures the response is thorough, accurate, and within regulatory timeframes.
Processes fax requests from the designated fax and system queues.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.