Utilization Management Coordinator (Hybrid) at Three Point Solutions Inc

Job Title: Utilization Management Coordinator I
Client: Healthcare Insurance Company
Duration: 12-Month Contract
Location: Baltimore, MD 21224 (Hybrid)

Job Description:
Purpose:

• Supports Utilization Management clinical teams by handling non-clinical administrative tasks related to pre-service, utilization review, care coordination, and quality of care.

Essential Functions:

• 35%: Member or provider-related administrative support, including benefit verification, authorization management, claims inquiries, and case documentation.
• 35%: Reviews authorization requests for initial determination or triages for clinical review.
• 20%: General support and coordination, including answering calls, taking messages, writing letters, researching, and solving problems.
• 10%: Assists with reporting, data tracking, and dissemination of information, such as Continuity of Care processes and Peer to Peer reviews.

Qualifications:

• High School Diploma.
• 3 years' experience in healthcare claims/service areas or office support.

Preferred Qualifications:

• 2 years' experience in healthcare/managed care or previous division work experience.
• Knowledge of CPT and ICD-10 coding.

Knowledge, Skills, and Abilities (KSAs):

• Effective participation in multi-disciplinary teams.
• Excellent communication, organizational, and customer service skills.
• Knowledge of medical terminology and managed care concepts.
• Proficient in evaluating medical support operations business practices.
• Strong independent judgment and decision-making skills.
• Attention to detail and proficiency with web-based technology and Microsoft Office.
• Ability to work in fast-paced environments with changing priorities.
• Positive customer service, even with demanding customers.

Top 5 Required Skills:

• Medical background
• Computer skills
• Medical terminology
• Claims and service office support
• CPT and ICD-10 coding