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Utilization Management Rep I

Company: Volt
Location: Meridian
Posted on: October 31, 2019

Job Description:

Utilization Management Rep IUnder general supervision, 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.MINIMUM POSITION REQUIREMENTS:Required Experience: Two years administrative support within a health insurance, health care, or health related-- industryRequired Knowledge, Skills and Abilities (KSAs):Knowledge of: Medical insurance and member contract languageSkills: Medical terminology Microsoft Word - Basic Coding (HCPCS, CPT--, ICD-9-CM and ICD-10) Verbal & written communication Detail oriented Problem solving Personal computerAbility to: Be a supportive team member Prioritize Multi-taskPREFERRED QUALIFICATIONS: Knowledge of Facets application Front medical office or billing experience Supportive team memberPRIMARY ACCOUNTABILITIES: Accurately review member eligibility and benefit structure for requested referrals or prior authorizations. Accurately respond to incoming calls from internal and external customers via multiple types of media. Request additional information needed to complete review of requested services. Initialize, route and complete as appropriate request for services.-- Inform members and providers of determination via telephone, electronic mail, fax or system generated, or customized written letter. Review medical documentation for completion. Return incomplete submissions to the sender. Accurately enter and maintain documentation per--workflows, policy and procedures. Review and work designated reports and programs as assigned. Complete correspondence according to established workflows. Assure compliance with company/department policies & procedures and member and provider contract requirements.SECONDARY ACCOUNTABILITIES: Participate in the development and implementation of BCI/HCO workflows, policies and procedures. Cross train within similar job categories. Perform other duties as requested by the Supervisor.

Keywords: Volt, Meridian , Utilization Management Rep I, Executive , Meridian, Idaho

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