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Utilization Management Technical Assistant II

Posted on Sep 19, 2021 by Dean Health

Madison, WI 53706
Admin & Secretarial
Immediate Start
Annual Salary
Full-Time


Assists with advanced clerical support and data entry of utilization management (UM) related activities, functions as a liaison to other departments regarding workflow and responsibilities of UM activities. Serves as a primary resource for questions regarding overall authorization entry processes, as well as phone triage and claims/customer service issues and concerns. Provides training and guidance for staff, as identified by the immediate supervisor.

PRIMARY RESPONSIBILITIES

  • Completes data entry of inpatient and outpatient service requests for all product lines and complexity levels.
  • Processes outpatient service requests using tools and processes.
  • Initiates and responds to identified issues from other departments, via claims payment system.
  • Triage and addresses incoming requests from customer care center, providers, medical directors (phone/fax/mail) related to UM activities and transfers requests, as appropriate.
  • Works collaboratively and supports the efforts of UM Reviewer RN team members.
  • Provides initial and ongoing training assistance to UM technical staff, as assigned.
  • Participates in the identification and review of claims issues. Participates in interdepartmental process improvement activities and audits.
  • Promotes timely and effective communication, based on individual and/or situational requirements.
  • Utilizes appropriate means to ensure adequate information flow.
  • Supports compliance with NCQA and governmental requirements, as appropriate to the position.
  • Performs other duties as assigned.

EDUCATION

  • High school diploma or equivalent

EXPERIENCE

  • Two years' clerical experience

PHYSICAL REQUIREMENTS

  • Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
  • Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
  • Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
  • Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
  • Frequent keyboard use/data entry.
  • Occasional bending, stooping, kneeling, squatting, twisting and gripping.
  • Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
  • Rare climbing.



Reference: 1327205936

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