- 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 - University Health Alliance
Description
Job Description
Job DescriptionJOIN UHA'S TEAM
We 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 yearHealth Care Services Specialist II
Department: Health Care Services
Salary level: 3
Position Summary:
Essential Duties & Responsibilities:
Required Education and Experience:
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.
Preferred and Advanced Qualifications:
· 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.
Competitive compensation & excellent benefits offered
Visit our website at to apply and for details about vacant positions.
An Equal Opportunity Employer
