CoreCare Utilization Management Specialist - VitalCore Health Strategies

Join the VitalCore Team in Kansas! We're people fueled by passion, not by profit!

VitalCore Health Strategies (VCHS), an industry leader in Correctional Healthcare, has an opening for a CoreCare Utilization Management Specialist at our Corporate Office in Topeka, Kansas! (Must be a certified Medical Coder with at least 10 years of experience).

Looking for a rewarding career with competitive wages, annual incentive bonus, and excellent benefits package?

At VitalCore we pride ourselves on retaining and acquiring compassionate, dedicated individuals who are committed to providing quality services. Join our team and experience first-hand how VitalCore Health Strategies promotes a positive work environment that is based on respect and appreciation of the hard work and dedication of our staff.

CORECARE UTILIZATION MANAGEMENT SPECIALIST BENEFITS PACKAGE:

• Holiday Pay: New Year’s Day, Martin Luther King Jr. Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Veteran’s Day, Thanksgiving Day, and Christmas Day
• Medical
• Dental
• Vision
• Health Savings Account
• Life Insurance
• Short Term/Long Term Disability
• Identity Theft Protection
• Pet Insurance
• Employee Assistance Program and Discount Center
• 401K & Plan Matching
• PTO
• Dependent Care Flexible Spending Account
• Annual Incentive Bonus

CORECARE UTILIZATION MANAGEMENT SPECIALIST POSITION SUMMARY

The CoreCare Utilization Management (UM) Specialist is responsible for the review of all applicable data to confirm the correct application of clinical and benefits administration procedural guidelines for all data related to patient claims processing. The CoreCare UM Specialist provides accurate, prompt, and appropriate medical authorization information to requests from Clinicians, Vendors, and Providers.

CORECARE UTILIZATION MANAGEMENT SPECIALIST ESSENTIAL FUNCTIONS

• Responsible for accurate flow of medical information between patients, outside providers and third-party payer.
• Researches and analyzes data for accuracy required for reimbursement.
• Analyzes medical billing and identifies documentation deficiencies.
• Uses established criteria to conduct preliminary decision review for services requiring prior authorization
• Assesses the need for additional information to complete a service decision request
• Works closely with UM RN staff to escalate decisions that require clinical review and oversight
• Communicates results of reviews in CoreCare Utilization Management program for the primary care team and clinical reviewers
• Handles all requests for review of authorization and data accuracy timely and accurately
• Follows department and organizational policies and procedures as well as adheres to all applicable regulatory, contractual, and compliance requirements

CORECARE UTILIZATION MANAGEMENT SPECIALIST REQUIRED EDUCATION, CERTIFICATIONS,AND EXPERIENCE:

• Associate’s Degree or equivalent experience – Bachelor’s Degree
• Certification in Medical Coding
• 10+ years professional work experience in health care, managed care, or insurance
• Education, training or experience as a medical coder, medical billing, Insurance Coordinator required
• English required, bilingual preferred
• Proficient in Microsoft Suite, specifically Excel

CORECARE UTILIZATION MANAGEMENT SPECIALIST MINIMUM REQUIREMENTS

• Great customer service skills, including interpersonal conversation, patience and empathy
• Great problem-solving and critical thinking skills
• Familiarity with utilization management review
• Knowledge of CPT and ICD coding highly preferred
• Flexibility and understanding of individualized care plans
• Excellent interpersonal, verbal, and written communication skills
• Ability to work independently and make decisions
• Work in a team based environment
• Excellent attention to detail
• Working knowledge of and ability to navigate through the healthcare system (insurances, Medicare, Medicaid, physician office operations)
• Experience with Crystal Reports preferred
• Ability to maintain the security of patient information/ adhere to HIPAA requirement

CORECARE UTILIZATION MANAGEMENT SPECIALIST SCHEDULE

• Full-time
• Mon-Fri
• 8AM – 5PM

VitalCore Health Strategies is an equal opportunity employer and committed to creating and maintaining an inclusive workplace in which all employees have an opportunity to participate and contribute to the success of the business and are valued for their skills, experience, and unique perspectives.

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