Utilization Management Assistant - Apex Systems

Job#: 2050600

Job Description:

Duties:
• Primarily responsible for processing initial incoming faxes or phone requests into the intake department
Gathering demographic and benefit data and documenting in appropriate system. This is determined through documented policy and procedures.
• Adheres to time frames, and turn around times, as evidenced by results of inter-rater reliability reviews.
• Routes and evaluates all calls and faxes to refer and assign as necessary to other staff.
• Performs data entry of authorization information into systems, and or fax information to, originating physician and or
facility or specialist.
• Implements nuances of product line and regulatory requirements in the processing of all authorization requests including
notification requirements.
• Responsible for confirming eligibility for requested authorizations and for requesting membership identification numbers
for newborns.
• Utilizes resources available. Reference may be made by phone or online. Dates must be
referenced prior to authorizations.
• Assists with complaint and appeal process regarding eligibility/claims and documents appropriately in the UM system.
Skills: 
• Managed care, preferably in medical management department, claims and member service background helpful. Health
care setting employment a plus.
• Ability to operate PC, Windows, Word, fax machine, photocopier, computer and multi-line telephone.
• Excellent customer service skills and phone etiquette are required.
• Ability to handle high volume of calls, prioritize work, be flexible and perform as member of a team is required.
• ICD and CPT coding skills (preferred)
Previous health plan experience is preferred.
No, certifications required. Typing and Data Entry is required. Medical Terminology (ICD – 10 & CPT coding, Place of service knowledge is required) Customer Service experience preferred.
Education:     
Required- H.S. Diploma or equivalent
 

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] or 844-463-6178.