Utilization Management Intake - Associate II

Utilization Management Intake Responsibilities include, but are not limited to, the following:

• Professional interaction with Nurses, Insurance Adjusters and other medical professionals.
• In-take / Data Entry of UM referrals and case assignment
• Evaluate faxes received by looking for identifying information and through thorough research in the Aerial system, file can be linked to opened requests by the clinicians that is instrumental in their completion of the review process.
• Scan, Uploadand labe case documents into the appropriate case files
• Handle Inbound faxes under the Managed Care Folder and ensure proper transmittal of documents to the appropriate queue.
• Collection of medical files and documents to be scanned, indexed and uploaded to Utilization Review case management application
• Separate and sort EMR and documents
• Properly determine the correct path for the services requested from the received fax and move to the appropriate clinician to review the case i.e. urgent care/non-urgent care that have different timetables/TAT that will impact NCQA

Qualifications

• Any college education
• At least 6 months of Healthcare BPO work experience
• Ability to multitask across multiple applications
• Strong analytical skills with excellent attention to detail
• Team player with excellent interpersonal skills
• Claims experience highly preferred