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Position Details:
Client : AmeriHealth
Job title : Utilization Management Tech
Location : 4390 Belle Oaks Drive, North Charleston, SC, 29405
Duration : 3 Months
Principal Accountabilities:
• Screens information received and refers members to the appropriate provider and/or contacts the provider directly for members.
• Facilitates the authorization process for requests that do not require clinical criteria application or judgment.
• Provides relevant information to members and assists them in resolving Plan related problems when Member Services personnel are not available.
• Acts as a resource to staff for questions related to the prior authorization process.
• Refers unresolved prior authorization process questions to the Lead Intake Specialist.
• Assists the Lead Intake Specialist in identifying, planning and implementing staff training programs.
• Identifies and reports member and provider educational opportunities to the Lead Intake Specialist.
• Accurately answers questions regarding Plan benefits and Utilization Management requirements for members and providers.
• Makes appropriate inquiries to determine potential coordination of benefits and advises appropriate provider and claims staff of same.
• Performs other duties as assigned.
• Adheres to Select Health and KMHP policies and procedures.
• Supports and carries out the Select Health and Mercy Mission & Values.
Skills:
• Customer service experience and interpersonal skills on phone and in-person
• Proficient PC Skills in a Windows based environment including word processing, spread sheets and working in database programs.
• Working knowledge of plan benefits and services
• Proven ability to keep accurate and timely records and documentation according to established processes
Education:
•High School Diploma / GED
Skills and Experience:
Required Skills:
• Data entry
• documentation
• answering phones
• excellent multitasker
• medical terminology
Additional Skills:
• Database
• word
• customer service
• customer service oriented
• Microsoft word
Minimum Degree Required:
• Completed High School (Diploma or GED)
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