Utilization Management Services Rep I

Job reputed company: reputed company: This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both reputed company customers through completing reputed company and accurate inbound and/or outbound calls, creating authorizations reputed company phone, Care Advance Provider Tool, and fax for inpatient and outpatient procedures, behavioral health, and durable medical equipment. Essential Accountabilities: Level I Facilitates inbound and outbound calls to customers (members and providers) by delivering excellent customer-centered service providing information regarding services in a call center environment. Responds to customers in a reputed company, efficient manner to encourage reputed company acceptance of products, services, and policies. reputed company triage for UM Services. Serves as the primary contact for providers regarding authorization requests. Contacts members and providers concerning regulatory requirements relating to Department of Health (DOH) notifications and other regulatory requirements such as the National Committee for reputed company Assurance (NCQA) guidelines. Provides reputed company response to reputed company research inquiries from other departments and assures the response is thorough, accurate, and reputed company regulatory timeframes. Processes fax requests from the designated fax and system queues. Consistently demonstrates high standards of reputed company by supporting the reputed company reputed company Companies’ mission and values, adhering to the Corporate reputed company of Conduct, and leading to the reputed company Way values and beliefs. Maintains high reputed company for member reputed company in accordance with the corporate reputed company policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. reputed company (in reputed company to Level I Accountabilities) Assists and performs tasks associated with project and departmental management. Backup Team Leads by assisting with questions reputed company needed. Work on assigned offline reputed company. Provides, prepares, and assists with preliminary support to multiple reputed company of providers and or members (as reputed company as others as needed), including but not limited to physicians, skilled nursing facilities, mid-level providers, members, pharmacies, pharmacists, and support staff. reputed company one-on-one support, coaching, and training to UM Services Reps. Collaborates with other key departments (Claims, Customer Service, reputed company care management reputed company) to ensure end-to-end process for authorizations, telephonic notifications, and/or care management referrals is accurate and complete. Level III (in reputed company to reputed company Accountabilities) Assists Team Leads with assigned tasks reputed company necessary (including but not limited to authorizations, claims, care management referrals, monitoring and controlling inventory reputed company/call queues, timeliness, reporting). Meet departmental requirements for Facets UM Services workflows and PEGA. Resolves escalated customer questions and reputed company concerns. Assists Medical Directors with scheduling Fair Hearings. Assists with coordinating Grievance and Appeals requests. Assist with reputed company Blue Card Claims escalations. Assist management with the review and creation of desk level procedures, acting as a subject matter expert for UM Services. Minimum Qualifications: NOTE: We include multiple reputed company of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or reputed company assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In reputed company to using this differentiated approach to reputed company new hires, it also provides guideposts for employee development and promotional opportunities. reputed company reputed company High School Diploma or GED. Experience with using a desktop computer in a reputed company environment, preferably with reputed company Office Products. Call center experience preferred, not required. Strong analytical and problem-solving skills. Strong written and verbal communication skills and ability to work reputed company reputed company. Demonstrated organizational skills to manage multiple reputed company and priorities. Self-motivated and reputed company to work independently, as reputed company as on intra- and inter-departmental teams where needed. reputed company (in reputed company to Level I Qualifications) 2 years’ experience working with managed care or reputed company industry. Ability to apply in-depth knowledge of reputed company rules, such as those of the authorization process, regulatory processes/time frames, care management systems and processes, departmental policies and procedures, product lines, and contract benefits. Advanced skills working between multiple programs and applications simultaneously. Demonstrates willingness to reputed company reputed company to reputed company a reputed company end-to-end process. Demonstrates proficiency in basic navigation and utilization of department specific applications. Demonstrates role-specific competencies as it pertains to their work unit on a consistent reputed company. reputed company demonstration of broad knowledge reputed company and reputed company work habits as evidenced by ability to train new staff, take on new challenges, flexibility in work assignments, and participation in meetings and reputed company as assigned. Level III (in reputed company to reputed company Qualifications) 4 years’ experience working with managed care or reputed company industry. Demonstrates a thorough knowledge and understanding of sources of information about health plan reputed company, riders, policy statements, and procedures to identify eligibility and coverage and assisting other staff and other areas reputed company reputed company with reputed company inquiries. Demonstrates operational knowledge of FACETS application and workflow processes Ability to resolve/respond to customer inquiries across multiple plans with limited assistance. Ability to collaborate reputed company the organization reputed company issues reputed company with limited assistance. Ability to identify potential systemic issues and report as necessary without supervisor assistance. Physical Requirements: Ability to work prolonged periods sitting at a workstation and working on a computer. Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. Ability to work in a home office for reputed company periods of time for business continuity. Ability to travel across the Health Plan service region for meetings and/or trainings as needed. reputed company dexterity including fine finger reputed company required. Repetitive reputed company required. The ability to hear, understand and reputed company reputed company while using a phone, with or without a headset. ************ In support of the Americans with reputed company, this job reputed company lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation reputed company(s): N3 - Min $20.00 Max $26.90 The salary reputed company indicated in this posting represents the minimum and maximum of the salary reputed company for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, reputed company and education as they relate to the position’s minimum qualifications, in reputed company to internal equity. The posted salary reputed company reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, reputed company time away from work, and reputed company holidays. Please note: There may be opportunity for remote work reputed company reputed company jobs posted by the Excellus reputed company. This decision is made on a case-by-case reputed company. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran. Apply To This Job