Utilization Management Technical Assistant II
Posted on Sep 19, 2021 by Dean Health
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.
- 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.
- High school diploma or equivalent
- Two years' clerical experience
- 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.