Utilization Management Support Specialist - Lumen Solutions Group, Inc.
Baltimore, MD 21224
About the Job
Purpose:
Provide administrative support to the Utilization Management clinical teams by handling non-clinical tasks related to pre-service, utilization review, care coordination, and quality of care.
Key Responsibilities:
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Member/Provider Support (35%)
Perform administrative tasks, such as benefit verification, authorization management, claims inquiries, and documentation for case files. -
Authorization Review (35%)
Review authorization requests, determining if clinical review is needed or making initial decisions when appropriate. -
Department Coordination (20%)
Provide general support, including answering calls, taking messages, drafting correspondence, researching information, and assisting in problem-solving. -
Reporting & Data Management (10%)
Assist with reporting and tracking processes such as Continuity of Care and Peer-to-Peer reviews, including data organization and dissemination.
Qualifications:
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Education:
High School Diploma (Required) -
Experience:
- 3 years of experience in healthcare claims, service areas, or office support (Required)
- 2 years of experience in a healthcare or managed care setting (Preferred)
- Knowledge of CPT and ICD-10 coding (Preferred)
Skills & Competencies:
- Proficiency in medical terminology and concepts used in managed care.
- Excellent communication, organizational, and customer service skills.
- Strong independent judgment, with the ability to handle sensitive tasks tactfully.
- High attention to detail in all tasks and projects.
- Strong computer skills, particularly in Microsoft Office (Word, Excel, PowerPoint).
- Experience in using web-based technology.
- Ability to effectively collaborate with internal and external stakeholders in a multidisciplinary team environment.
Work Environment:
Must be able to thrive in a fast-paced environment with frequently shifting priorities, meeting multiple deadlines, and handling diverse customer service demands.