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Utilization Management Tech - Office Based - Phoenix, AZ
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Phoenix, AZ Phoenix, Arizona |
About this job
Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)
Careers at OptumHealth. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen.
North American Medical Management (NAMM) specializes in working with leading physicians and hospitals to successfully manage the delivery of medical services. We have developed sophisticated techniques for managing the revenue and health care expenses of medical groups.
Our customer service teams have a serious responsibility to make every contact informative, productive, positive, and memorable for what it says about how much we care.
The Utilization Management (UM) Tech is accountable for initiation of the referral as well as pre-authorization, concurrent review and retrospective data collection. The UM Tech also performs triage, data entry, coding, research and notification of status for patients assigned to physicians participating in the IPA. The UM Tech must understand and perform work functions to maintain timeliness and compliance standards for specific lines of business.
Responsibilities of the UM Tech include (but are not limited to):
- Verifying eligibility and benefits for each referral/authorization
- Inputting all referrals into referral UM computer system and assigns to appropriate staff for completion
- Providing referral and authorization confirmation to external providers via telephone or US mail
- Communicating authorization status to patients, providers and facilities per policy
- Organizing and maintaining electronic filing system of authorization/referral and hard copy files as required by policy
- Providing clinical and plan coverage information to support Denial of Services process and for authorization requests for Non-covered Services and Benefits
- Returning incomplete requests to requestor noting what additional information or documentation is required and places in pend status per department policy
- Inputting ICD codes and CPT codes in UM computer data base per established policy and procedure
- Preparing assigned correspondence and reporting and compiling statistical data as directed
- Tracking all Referral Requests through data entry, maintaining data systems, logging per policy and procedure, and compiling statistics monthly as directed
- Maintaining good attendance
- Representing department / group and organization in a professional and positive manner
- Supporting and facilitating teamwork within the department / group and the organization
- Participating in scheduled departmental / group meetings
Requirements
Required Qualifications:
- High school diploma or GED
- 1 year or more experience in the medical field either in a hospital, clinical or insurance setting that includes experience with computers
- Proficiency in Microsoft Office: Outlook, Word, Excel & PowerPoint
- Strong customer service skills
- A working knowledge of medical terminology and/or CPT/ICD coding
- Ability to successfully work in a dynamic environment
- Excellent written and verbal communication skills
- Demonstrates excellence and high quality in performing responsibilities
- Demonstrates ability to work independently when supervisor is at outside business appointments
Preferred Assets:
- Medical Terminology certificate
- Medical Assistant and/or Certified Nursing Assistant
- CPC coding certification
At OptumHealth we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.SM
NAMM and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations.
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Job Keywords: office based, clinic, utilization management, physician office, managed care, administrative, Phoenix, AZ, Arizona