Full-Time Utilization Management Support Specialist
The Utilization Management Support Specialist provides various critical components necessary to day-to-day operational functions while ensuring proper workflow between the Utilization Management Department, providers and internal departments. The Utilization Management Support Specialist coordinates Continuation of Care orthodontic benefits.
PRIMARY JOB RESPONSIBILITIES:
- Determine dollar amount, calculate financial responsibility, and enter Orthodontic Continuation of Care cases based on prior claims submitted, submitted explanation of benefits, treatment plan and other supporting documentation.
- Review, research and respond to inquiries routed via telephone, follow-ups, and email.
- Investigate and manage orthodontic reimbursement inquiries with Client/Provider Engagement, Claims, and Customer Service departments.
- Verbally communicate authorization decisions to providers, request additional information when necessary, and appropriately document the phone call in DentaQuest’s system.
- Coordinate, manage and distribute incoming faxes to facilitate distribution to appropriate parties within the organization.
- Assemble Ortho CAD (electronic orthodontic requests) submission forms in preparation for review.
- Prepare and Coordinate general anesthesia/IV requests Organize, coordinate and communicate Outpatient Facility Requests to appropriate State and/or Managed Care Organizations.
- Process requests received in the Outpatient Facility Specialist queue.
- Communicate to management ways to improve processes and productivity of company.
- Adhere to DentaQuest business processes.
- Assist with administrative and other duties as assigned.
- High School Diploma or equivalent.
- 1 year experience in clerical setting
- Knowledge of general computer software.
- Knowledge of telephone systems.
- Knowledge of dental terminology.
- Typing skills of 30+ wpm.
- Ability to read Explanation of Benefits.
- Good interpersonal skills.
- Ability to work independently.
- Good PC Skills.
- Excellent verbal communication skills.
- Excellent mathematical skills.
- Excellent analytical skills.
- Good judgment and ability to resolve payment issues.
- Ability to prioritize and organize multiple tasks.
- Ability to remain organized with multiple interruptions.
- Required to attend additional training as requested/deemed necessary.
- Incumbent must be able to communicate effectively.
- Requires overall light physical effort (up to 25lbs.)
- Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal computer).
- Ability to travel or move about within and outside serviced facilities required.
- Incumbent works primarily in either a private or shared office environment.
How to ApplyTo be considered for this role, please apply here: http://gr.8job.co/vcD1mB6A
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