Utilization Management Support Specialist - Lumen Solutions Group, Inc.

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:

• 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:

• 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.