- Conduct administrative functions for the Health Care Services Administration team; and to serve as a backup with any other duties needed
- Provide general administration support to the Health Care Services department (ie: management, clinical & data analytics teams)
- Maintain and follow department policy and procedures as required
- Maintain and ensure URAC standards, criteria, and guidelines
- Handle inbound and outbound telephone calls (ie: prior authorization status inquiries, research of ICD, CPT, & HCPCS codes)
- Discuss inquiries with other staff and/or departments to resolve any issues
- Request additional clinical notes as needed
- Retrieve messages from the telephone answer service and add messages to the Voicemail Spreadsheet
- Assist with non-clinical review of prior authorizations, data entry, and proper process for clinical review
- Retrieve electronic files/faxes
- Assign to the appropriate staff, prior authorization file and/or designated folder
- Open, scan and distribute mail
- Coordinate meetings and conference calls by confirming availability of all participants as well as availability of conference room or offsite facility
- Electronic filing of completed member records and/or any other miscellaneous documentation
- Process and distribute HCS Daily Reports to the HCS clinical & non-clinical staff
- Process incoming drug request overrides (via phone or fax) by determining validity of the request; if not sent to the PBM
- Process & distribute the daily Inpatient Hospital Census Report to the clinical team
- Acquire hospital discharges daily
- Serve as a backup to HCS Specialist III to generate all administrative team letters (ie Approvals, Denials, Partials, LOIs, etc)
- Generate and process the Invalid Seen Date report
- Update the system as necessary or return the file to the proper HCS staff to make corrections
- Assist with the creation, updating and revising of Health Care Services educational materials as necessary, including PowerPoints or other materials
- Accurately maintain and update department policies and procedures, performing Quality Control (QC) reviews as necessary
- Perform other duties and/or projects as assigned by the HCS Supervisor or management
- Request for additional duties or to be crossed trained in other duties when workload permits
- This Position prohibits any activity that requires interpretation of clinical information to customers, including the choosing of a set of criteria to use for handling a request for healthcare services or treatment
- Two years of previous administrative or clerical experience, preferably in a health care related setting
- High School diploma or equivalent
- Requires frequent standing, sitting, stooping, walking, seeing, hearing, speaking
- Wearing of headsets required when answering phones
- This position is eligible to work from home and will rotate with team to work in the office to complete administrative tasks
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Health Care Services Specialist II - Honolulu, United States - UHA
Description
JOIN UHA'S TEAMWe focus on your health and pay 100% for your family's medical insurance and provide 20 days of paid personal time off during your first year
Health Care Services Specialist II
Department: Health Care Services
Salary level: 3
Position Summary:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Associates degree from an accredited university/college
• CPC (Certified Professional Coder) designation is desired
• Administrative or clerical experience in a health care related setting
Physical Demands/Working Conditions:
The work environment characteristics described here are representative of those associate encounters while performing the essential functions of this job.
Visit our website at to apply and for details about vacant positions.
An Equal Opportunity Employer
