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Sr. Utilization Management Specialist
Location
United States
Posted
10 days ago
Salary
Not specified
Job Description
Role Description
This role involves supporting the clinical team by handling administrative and non-clinical tasks essential for processing Utilization Management prior authorizations and appeals. Your contributions will ensure the efficiency and accuracy of operations within the UM process.
- Monitor incoming faxes for authorization requests
- Enter UM authorizations review requests using ICD-10 and HCPCS codes
- Verify eligibility and claims history in proprietary platforms
- Ensure all necessary documentation is submitted with authorization requests
- Contact providers to obtain required medical records
- Generate correspondence for member and provider notifications
- Complete verbal notifications and document activities
- Initiate appeal cases for UM Nurses
- Meet deadlines for UM cases as per internal and regulatory standards
- Assist UM Nurses with designated tasks
- Handle inquiries from call center and other sources
- Perform other duties assigned by the UM Director
Qualifications
- 1 year as a UM Coordinator in a managed care payer environment preferred
- Knowledge of ICD-10, HCPCS codes, and medical terminology required
- Strong time management and organizational skills to prioritize tasks
- Proficient in computer applications like Word and Outlook
- Ability to collect data, analyze facts, and draw valid conclusions
- Effective written and oral communication skills required
- Experience with DMEPOS is desired
- Medicare/Medicaid experience is a plus
Benefits
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance and short-term disability coverage
- Medical, Vision, and Dental benefits
- Paid Time Off (PTO) and Paid Parental Leave
- Sick Time and Paid company holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
Job Requirements
- 1 year as a UM Coordinator in a managed care payer environment preferred
- Knowledge of ICD-10, HCPCS codes, and medical terminology required
- Strong time management and organizational skills to prioritize tasks
- Proficient in computer applications like Word and Outlook
- Ability to collect data, analyze facts, and draw valid conclusions
- Effective written and oral communication skills required
- Experience with DMEPOS is desired
- Medicare/Medicaid experience is a plus
Benefits
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance and short-term disability coverage
- Medical, Vision, and Dental benefits
- Paid Time Off (PTO) and Paid Parental Leave
- Sick Time and Paid company holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
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