Utilization Management Specialist

Job Description:

Consideration will only be given only to candidates living in the Louisville Metro area.

ESSENTIAL JOB FUNCTIONS

•  Verifies client’s mental health, intellectual disability, and/or substance abuse benefits and obtains initial authorization and subsequent authorizations, as determined by guarantor.
• Verifies all commercial and Medicare Advantage plans for agency at intake and all reports related to changes to these guarantors.
• Works daily reports to move authorizations through life cycle of authorization from intake to discharge.
• Communicates guarantors needs to operations staff.
• Pulls necessary information from charts for retro reviews and appeals.
• Collaborates and educates operations staff on authorization process and status of their client’s request.
• Implements tracking system to obtain future authorizations and any other maintenance needed by guarantor.
• Resolves billing problems and/or receives insurance updates.

EDUCATION

• High School diploma: Associate degree preferred.

EXPERIENCE            

• Two years of administrative experience.

REQUIREMENTS

• Excellent observation skills, analytical thinking, problem-solving, and good verbal and written communication skills.
• Basic knowledge of managed care and reimbursement concepts
• Knowledgeable of medical terminology, CPT, HCPC, and revenue codes
• Excellent customer service skills

PHYSICAL DEMANDS

• The position requires lifting up to 20 pounds, with frequent lifting and/or carrying of items weighing up to 10 pounds.
• Occasional minor discomfort from continual exposure to a video display terminal.

Time Type: