Clinical Support Specialist - Utilization Mngmt

Job Description Qualifications Associate or High School Diploma degree required. Health care delivery, medical billing, coding and/or customer service experience. Knowledge of utilization management process (i.e., Health Center, Hospital, Insurance Company, Physician office) Knowledge of Utilization Management regulations and standards Experience with Medicare, Medicaid, and Commercial lines of business bilingual preferred. Salary: $23 - $25 per hour Shift: First Work hours: 8 AM - 4 PM Education: High School Responsibilities Provide support to UM Care Managers to ensure provider and member customer satisfaction. Process authorizations and referrals using desktop procedures and workflows Outreach providers for needed clinical information and upload to appropriate authorization in Mass General Brigham Health Plans’ online provider portal Strong knowledge and understanding of processing requests per Medicare, Medicaid, and commercial lines of business Meet quality standards per NCQA, CMS, DOI, and health plan regulations Ensure customer satisfaction to providers and members Respond in a timely and accurate manner to internal and external customer inquiries as per policies and procedures. Escalate urgent issues as appropriate. Achieve and maintain compliance with telephone accessibility Skills Authorizations Referrals Medical Billing Medical coding Utilization management Medicare/Medicaid Spanish Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status. At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on click.appcast.io. Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility). This posting is open for thirty (30) days. #J-18808-Ljbffr 6AM City, LLC