Utilization Management Support Specialist

SKYGEN

119d

About The Position

We’re creating a brand-new role—and you’ll be at the heart of shaping it! If you’re excited by fresh challenges, new regulations, and making a real impact, this is your chance to help lay the foundation. Collaborate with clinical staff and enjoy the dynamic healthcare space. Dive into compliance with a technical twist—perfect for curious minds. Flex your schedule! Core hours are Monday–Friday, 8 AM – 5 PM CST, but you’ll have room to adjust and make it work for you. Weekend rotation? Yes—but you’ll earn a $2/hour shift premium when it’s part of your regular schedule.

Requirements

• High school diploma or equivalent
• 2 plus years of job-related experience
• Excellent computer literacy including strong proficiency in Microsoft Office
• Ability to remain organized with multiple interruptions
• Excellent ability to organize work appropriately ensuring deadlines are met
• Excellent communication skills including both internal and external customers
• High attention to detail and accuracy
• Strong problem-solving skills to allow for the correct diagnosis of a problem along with potential solutions for resolution.
• Some knowledge of/prior use of SQL

Nice To Haves

• Associates degree or Bachelor’s degree
• Two or more years in a quality role
• Experience with healthcare terms
• Knowledge of dental and vision claims payment and billing processes
• Knowledge of general practices for appeals, complaints, and grievances handling
• Knowledge of federal and state regulations as it pertains to health care compliance
• Holds Enterprise System Certification (s)

Responsibilities

• Utilize internal practices and policies to perform regular audits of authorization case work performed by the administrative and clinical team.
• Provide administrative set up and technical support for authorization processing to ensure authorization service level agreements (SLAs) are met in accordance with contractual obligations and in compliance with regulatory requirements.
• Assist in determining root cause of quality issues and processing errors and recommend and implement appropriate solutions/controls to eliminate future errors.
• Perform daily audits of authorization turnaround times to ensure compliance is met, coordinating completion when necessary.
• Perform monthly (more frequent when needed) audits of authorizations worked by Authorization Support Representatives for quality and accuracy.
• Communicate with management and other internal staff on audit findings and provide any appropriate process change recommendations.
• Work with the UM Analyst to resolve any processing issues leading to audit concerns and recommend and implement appropriate solutions/controls including support of SKYGEN’s Internal Priority Quality Initiative (IPQI) processes and post implementation monitoring.
• Provide technical assistance to the clinical and administrative team to include, but not be limited to: system set up, attachment vendor set up, and day-to-day troubleshooting.
• Aid in configuration and auditing of authorization set up in the Enterprise System.
• Create and run SQL scripts to monitor SLA adherence and aid in authorization processing.
• Maintain current knowledge of Utilization Management/Authorization policies and procedures, URAC and NCQA standards.
• Work with the UM Analyst on tasks as assigned.
• Assist with ASR II/III tasks when necessary to meet compliance.
• Work with management staff to resolve any processing issues leading to audit concerns.

What This Job Offers

• Education Level: High school or GED