Primarily REMOTE, occasionally required onsite at the client's Baltimore, MD office.
Job Description Summary:
This role supports Utilization Management clinical teams by handling non-clinical administrative tasks related to pre-service, utilization review, care coordination, and quality of care. Training will be onsite, and the candidate must be able to perform duties effectively after training.
Key Responsibilities:
Provide administrative support for member/provider tasks, including benefit verification, authorization management, and claims inquiries.
Review authorization requests and triage for clinical review.
Assist with general coordination, including answering calls, researching information, and resolving issues.
Support data tracking, reporting, and information dissemination, such as Continuity of Care and Peer-to-Peer reviews.
Qualifications:
Education: High School Diploma
Experience: 3 years in healthcare claims/service areas or office support
Preferred: Experience in managed care, knowledge of CPT and ICD-10 coding.
Skills Needed:
Strong communication, organizational, and customer service skills
Proficient in medical terminology, web-based technology, and Microsoft Office tools (Word, Excel, PowerPoint).