TOP REQUIREMENTS:
1. Managing authorizations/notifications and other service requests received via incoming high volume phone calls, faxes and portal submission
2. Providing excellent customer service, including the ability to handle escalated callers.
3. Determining authorization or notification requirements

*** What experience will set candidates apart from one another? Call center experience.

*** Would like to start the interview process ASAP.

Position Description: This position is responsible for the daily coordination of UM processes in the Intake Call Center. This position serves as the initial intake of pre-service requests, claim reviews and inpatient hospital coordination and diabetic supplies. Coordinates UM processes with Medical Directors, UM Nurses, hospitals, physicians and other various departments. Provides clerical support to clinical staff in their medical necessity review process. UM Coordinator is expected to maintain production and quality standards.

RESPONSIBILITIES:
1. Managing authorizations/notifications and other service requests received via incoming high volume phone calls, faxes and portal submission
2. Providing excellent customer service, including the ability to handle escalated callers.
3. Determining authorization or notification requirements
4. Preparing authorization cases for Medical Directors, UM Nurses and Case Managers
5. Handling expedited authorizations, authorization updates and status checks
6. Confirming member eligibility
7. Responsible for outreaches to providers and/or Patient to complete authorization requests and prescriptions.
8. Maintaining knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
9. Utilizing experience and judgement to plan, accomplish goals and effectively resolve each assigned task.
10. Non-Clinical staff is not responsible for conducting any UM activity that requires interpretation of clinical information.
11. Performs all other related duties as assigned.


Minimum Required Education, Experience & Skills:
- 1 or more year’s previous related experience in any of the following or combination thereof: healthcare, call center, and/or customer service setting using the telephone and computer as the primary instrument to perform job duties.
- Medical Terminology, ICD-9/ICD-10 and CPT Knowledge.
- Proficiency with Microsoft Office applications required, i.e Excel, Access, Outlook.
- Ability to work the hours of 9am-6pm Monday-Friday and the hours of 8am-5pm on rotating weekends and holidays.

ADDITIONAL DETAILS:
• What software skills are needed? Knowledge of Outlook, familiarity with Citrix, CMS Avaya, Salesforce, Rightfax, and Trucare
• What are the hours? ( Training hours?) Office hours 9a-6p and training hours 9-6
• Will you be interviewing (face to face or phone): face to face interview/group panel
• Please confirm the worksite location - 5800 Northwest Parkway Ste. 125 Moving to new location in early November 2019- will notify during interview.

Preferred Education, Experience & Skills:
- Associate’s Degree in a healthcare related field

Physical & Mental Requirements:
- Ability to lift up to 10 pounds
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to properly drive and operate a company vehicle
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving