Utilization Management Coordinator (Hybrid) at Three Point Solutions Inc

Job Title: Utilization Management Coordinator(Hybrid)

Client: Health Care Industry

Duration: 12 months contract with possible extension

Location: Baltimore, MD, 21224 (DMV Candidates only, District of Columbia, Maryland and Virginia)

Job Description:

Purpose:
Support Utilization Management clinical teams by assisting with non-clinical administrative tasks related to pre-service, utilization review, care coordination, and quality of care.

Top 5 Required Skills:
Medical background, computer skills, medical terminology, claims and service office support, CPT and ICD-10 coding

Essential Functions:

• 35% Perform member or provider related administrative support (e.g., benefit verification, authorization management, claims inquiries, case documentation)
• 35% Review authorization requests for initial determination or triage for clinical review
• 20% Provide general departmental support (e.g., answering calls, correspondence, problem-solving)
• 10% Assist with reporting, data tracking, and organization (e.g., Continuity of Care process, Peer to Peer reviews)

Qualifications:

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

Preferred Qualifications:

• Two years' experience in health care/managed care setting or previous division work experience
• Knowledge of CPT and ICD-10 coding

Knowledge, Skills, and Abilities (KSAs):

• Ability to participate effectively in multi-disciplinary teams
• Excellent communication, organizational, and customer service skills
• Knowledge of basic medical terminology and managed care concepts
• Familiarity with standardized processes and procedures in medical support operations
• Strong independent judgment, decision-making skills, tact, and diplomacy
• Attention to detail in project or task management
• Proficiency in web-based technology, Microsoft Office applications (Word, Excel, PowerPoint)