No more applications are being accepted for this job
- Enter cases into the UM system and forward to clinical staff for review
- Make calls to members and providers when additional information is required
- Transcribe all department voice mails into the UM system
- Review claims for pricing and benefits
- Initiate and monitor any reports necessary to operate efficiently
- Review all work received into the Utilization Management department
- Engages in screening activities that do not require clinical evaluation or interpretation, including review of appeal requests for completeness, collection and transfer of non-clinical data, or acquisition of structured clinical data.
- Has access for consultation to licensed clinicians, while conducting all screening activities.
- Keep all subscriber Personal Health Information (PHI) confidential
- Follow and adhere to appropriate guidelines and laws applicable to duties (HIPAA, ERISA, URAC, etc.)
- Interact well with other departments
- Other duties as assigned.
- Must have good organizational skills
- Computer literacy and the skill required to complete job functions
- Must be knowledgeable about and/or have the ability to learn various computer applications including Microsoft (MS) Word and MS Excel
- Professional phone and communication skills required
- Must be self-motivated, a quick learner and have the ability to adapt to change
- This position works under general supervision; work is subject to specific performance and accuracy guidelines or specified production time
- High School degree or equivalent
- Experience in health and/or health related field is desired
- Two (2) years prior office experience preferred.
- Standing, walking, and sitting.
- Lifting and/or moving up to 10 pounds; occasionally lifting and/or move up to 25 pounds short distances.
- Usage of close vision, distance vision, and ability to adjust focus.
- Manipulation of keyboards, keypads, and calculators.
- Placing and answering telephone calls.
- Focused task tracking and follow-through.
- Some interpersonal tension in problem-solving/resolution interactions.
- Speaking/presenting to internal and external audiences of diverse sizes.
- Work environment noise level that is usually moderate.
- Open office environment with few, if any, loud sounds, or ongoing auditory distractions.
- Some deadline related stress.
- As needed evening and weekend hours on a periodic basis.
- Minimal travel, typically in-state.
UM Case Representative - Cheyenne, United States - Blue Cross and Blue Shield Association
Description
Job Description Summary:
Gather, organize and coordinate all work received into the Utilization Management department and enter in the UM processing system.
Job Description:
JOB SUMMARY
Gather, organize and coordinate all work received into the Utilization Management department and enter in the UM processing system.
ESSENTIAL DUTIES & RESPONSIBILITIES
QUALIFICATIONS
While performing the essential duties of this position, an employee will typically experience:
To perform successfully in this position, an individual must be able to perform essential duties satisfactorily as well as possess education/experience, knowledge, skill, and abilities (KSA) as listed in representative fashion; reasonable accommodations may be made to enable individuals with limitations/disabilities to perform the essential functions of this position.