13 Feb 2020

Full-Time Utilization Management Support Specialist

RecruitDQ – Posted by RecruitDQ Milwaukee, Wisconsin, United States

Job Description

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.

JOB REQUIREMENTS:

Required:

  • 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.

PHYSICAL DEMANDS:

  • 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 Apply

To be considered for this role, please apply here: http://gr.8job.co/vcD1mB6A

Job Categories: Equal Opportunities. Job Types: Full-Time.

Job expires in 82 days.

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