Utilization Mgmt Spec

Corewell Health • Southfield, MI

3d • Onsite

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. 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.

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

• 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.
• 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.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED