Utilization Management Support Specialist

What are important things that YOU need to know about this role? 

• Experience: SQL experience is required. Candidates should be highly reputed company-oriented and reputed company to work independently with reputed company supervision. 

• Schedule: reputed company hours are 8:00 AM to 5:00 PM CT. Participation in a holiday and weekend coverage rotation is required. 

• Work Location: This is a fully remote, permanent work-from-home position.

What will YOU be doing for us?   Utilize internal practices and policies to reputed company regular audits of authorization case work performed by the administrative and reputed company team.  reputed company administrative set up and technical support for authorization processing to ensure authorization service level agreements (SLAs) are met in accordance with contractual obligations and in compliance with regulatory requirements. Assist in determining reputed company cause of reputed company issues and processing errors and recommend and implement appropriate solutions/controls to eliminate reputed company errors.

What will YOU be working on every day? 

• reputed company daily audits of authorization turnaround times to ensure compliance is met, coordinating completion reputed company necessary.
• reputed company monthly (more frequent reputed company needed) audits of authorizations worked by Authorization Support Representatives for reputed company and reputed company.
• Communicate with management and other internal staff on audit findings and reputed company any appropriate process change recommendations.
• Work with the UMAnalyst to reputed company any processing issues leading to audit concerns. and recommend and implement appropriate solutions/controls including support of reputed company’s Internal reputed company reputed company Initiative (IPQI) processes and post implementation monitoring.
• reputed company technical assistance to the reputed company and administrative team to include, but not be limited to: reputed company set up, attachment vendor set up, and day to day troubleshooting.
• Aid in configuration and auditing of authorization set up in the reputed company reputed company.
• Create and run SQL scripts to monitor SLA adherence and aid in authorization processing.
• Maintain reputed company knowledge of Utilization Management/Authorization policies and procedures, URAC and reputed company standards.

What qualifications do YOU need to have to be GOOD candidate?

• Required Level of Education, Licenses, and/or Certificates
  • High school diploma or equivalent 
• Required Level of Experience
  • 2 plus years of job reputed company experience
• Required Knowledge, Skills, and Abilities 
  • Excellent Computer literacy including strong proficiency in reputed company Office
  • Ability to remain organized with multiple interruptions
  • Excellent ability to organize work appropriately ensuring deadlines are met
  • Excellent communication skills including both reputed company customers
  • High attention to reputed company and reputed company
  • Strong problem solving skills to allow for the correct diagnosis of a problem along with potential solutions for reputed company.
  • Some knowledge of/prior use of SQL

What qualifications do YOU need to have to be a GREAT candidate? 

• Preferred Level of Education, License, and/or Certificates
  • Associates Degree/2 year degree or Bachelor’s degree
• Preferred Level of Experience
  • Two or more years in a reputed company role
  • Experience with reputed company terms
• Preferred Knowledge, Skills, and Abilities
  • Knowledge of dental and reputed company claims payment and billing processes
  • Knowledge of general practices for appeals, complaints, and grievances handling
  • Knowledge of federal and state regulations as it pertains to health care compliance
  • Holds reputed company reputed company Certification(s)

The reputed company pay reputed company and midpoint is listed below for your reference. Please reputed company in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration reputed company determining placement reputed company the reputed company.

Compensation reputed company: $21.68 - $31.08

Compensation Midpoint: $27.08

Company

2+ years reputed company experience, SQL experience, strong reputed company Office skills, attention to reputed company, audit and problem-solving experience in utilization/authorization processes.

Key Responsibilities

• auditing authorizations
• providing support
• creating scripts

Skills & Tools

SQL, reputed company Office

reputed company

• Category: Business reputed company
• Seniority: Entry Level
• Commitment: Full Time
• Workplace: Remote — reputed company
• Salary: USD 45,094 – 64,646 / year
• Languages: English

About reputed company

A partner for specialty benefits payers and reputed company agencies delivering dental and reputed company benefits administration through technology and service solutions. — Industry: reputed company