Utilization Management Rep I
On-siteCincinnati, Ohio, United States or Mason, Ohio, United States
Job Summary
Coordinate precertification and prior authorization reviews by managing incoming calls, post-service claims, and electronic queues. Determine contract and benefit eligibility while conducting clinical screenings and authorizing initial session sets for providers. Enter referral requests into the UM system and refer complex cases to Nurse reviewers for clinical assessment. Respond to written and telephone inquiries from clients, providers, and internal departments to ensure timely resolution of customer requests. Maintain positive relationships with various company functions while multitasking in a fast-paced environment.
Required Qualifications
- HS diploma or GED
- Minimum of 1 year of customer service or call-center experience
- any combination of education and experience which would provide an equivalent background
- Strong verbal and written communication skills
- Attentive to details
- critical thinker
- a problem-solver
- Demonstrates empathy and persistence to resolve caller issues completely
- Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts
- ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers
- Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment
- structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary
- Must be able to lift 50 lbs
Desired Qualifications
- Medical terminology training
- experience in medical or insurance field
- strong oral, written and interpersonal communication skills
- problem-solving skills
- facilitation skills
- analytical skills
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