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Respond to provider queries, enter administrative authorization data into the computer system, and maintain proper documentation and files to support care of members, customer service, and other departmental functions. Enters all referral/data information into the computer system, maintains proper documentation and facilitates coordination of services. The position will be directly associated with incoming referrals and authorizations for the utilization component of medical management.

Key Responsibilities/Duties – what you will be doing:

+ Receives incoming authorization requests from providers, via fax, portal & telephone to create an event or transaction by lines of business for the UM teams to review and decision requests

+ Contacts provider offices for further details on clinical information.

+ Research member eligibility and primary care selection to complete entry of the event.

+ Documents and maintains all telephone calls and enters a note on each call/inquiry made. Documents all admissions, and referrals. Maintains flow and storage of information such as messages, forms, and logs.

+ Works with providers and other members to solve complex and urgent issues. Ensures that appropriate person/department from across the organization is appropriately involved with applicable issues.

+ Data entry of Authorization Requests for all Inpatient stays – Outpatient requests as needed, into information system.

+ Represents Medical Management at applicable activities including system user groups and other health data system organizations.

+ Attends organization-wide meetings and department staff meetings.

+ Maintains professional growth and development through self-directed learning activities and involvement in professional, civic and community organizations.

+ Other duties as assigned by the Intake and Outreach Coordination leadership.

Qualifications – what you need to perform the job Certification and Licensure Education

+ Required (minimum): Associates’ degree or equivalent relevant work experience.

+ Preferred:

Experience

+ Required (minimum): Two plus years of experience in a business environment

+ Preferred: Managed care/health industry environment experience.

Skill Requirements

+ Exhibits exceptional internal and external customer service skills.

+ Ability to work in clinical and company databases

+ Excellent verbal and written communication skills generally acquired through college or other advanced education are required.

+ Must be able to demonstrate proficiency and accuracy in performing data entry tasks in multiple applications

+ Individuals must be able to appropriately identify urgent situations and follow the appropriate protocol.

+ Position also requires the ability to manage multiple priorities as well as having the initiative, judgment, and perception to operate independently and in a partnership with other departments.

+ Individuals must possess strong organizational and problem-solving skills and the attention to detail necessary to act within this complex environment.

+ Requires excellent interpersonal skills.

+ Position requires daily contact, by telephone, with network providers and their office staff, hospital contacts and Point32Health internal departments.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

+ Fast paced office environment handling multiple demands.

+ Must be able to exercise appropriate judgment, as necessary.

+ Must be able to work under normal office conditions and work from home as required.

+ Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.