Utilization Management Assistant

Utilization Management Assistant

We're hunting for a Utilization Management Assistant, someone who's ready to be part of a growing team with amazing opportunities. Receives, processes and completes data entry of demographic information on all referral/authorization requests from participating providers via fax or phone. Assists and collaborates with all medical management staff, as well as other health plan staff, e.g. Claims Department, Network Development. Provides customer service and education for all incoming calls regarding provider and/or product information.

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Job Duties & Responsibilities

• Serves as support to Medical Management Intake Department
• Primarily responsible for processing initial incoming faxes or phone requests into the intake department Gathering demographic and benefit data and documenting in appropriate system. This is determined through documented policy and procedures.
• Adheres to time frames, and turnaround times, as evidenced by results of inter-rater reliability reviews.
• Routes and evaluates all calls and faxes to refer to and assign as necessary to other staff.
• Performs data entry of authorization information into systems, and or fax information to, originating physicians, or facility or specialist.
• Implements nuances of product line and regulatory requirements in the processing of all authorization requests including notification requirements.
• Responsible for confirming eligibility for requested authorizations and for requesting membership identification numbers for newborns.
• Educates providers on authorization requirements and processes and Policy and Procedures of the Health Plan.
• Receives transfer calls from member services relating to authorization issues, questions or capabilities of service providers.

Skills & Requirements

• H.S. Diploma or GED required
• Some college course work preferred
• 2 years managed care, preferably in medical management department, claims and member service
• Experience in Healthcare or Insurance environment

Texas Children's Hospital