Utilization Management Specialist
About The Position
Under general direction, assists in the provision of the highest service level possible to patients/customers to ensure their satisfaction. Participates in activities with third party payors in order to maximize reimbursement. As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
Requirements
- High School Diploma or equivalent
Nice To Haves
- Post high school training and/or academic coursework leading toward associate’s or bachelor’s degree.
- 2 years of relevant experience healthcare experience.
Responsibilities
- Understands and accesses insurance websites.
- Completes required duties as defined for specific payers to obtain authorization numbers for payment.
- Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with outpatient or inpatient status.
- Utilizes electronic medical record work queues that support Utilization Management functions.
- Answers incoming calls or places outbound calls with appropriate communication skills.
- Triages all calls to the appropriate person for resolution and action or completes appropriate follow-up.
- Problem solves issues that are received via phone, fax or email.
- Other duties as assigned.
Benefits
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance, pet insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
