Utilization Management Rep
Bcidaho

Our Utilization Management Rep will coordinate and manage incoming and outgoing correspondence to include referrals, prior authorizations, provider reconsiderations and other requests for service. Verify provider contracting status and member eligibility to include any applicable pre-existing period. Communicate and coordinate with providers to obtain and verify information related to such requests.

We're looking for Utilization Management Rep with:

• Two years administrative support within a health insurance, health care, or health related industry

What a day of a Utilization Management Rep would look like:

• Accurately review member eligibility and benefit structure for requested referrals or prior authorizations.
• Accurately respond to incoming calls from internal and external customers via multiple types of media.
• Request additional information needed to complete review of requested services.
• Initialize, route and complete as appropriate request for services. Inform members and providers of determination via telephone, electronic mail, fax or system generated, or customized written letter.
• Review medical documentation for completion. Return incomplete submissions to the sender.
• Accurately enter and maintain documentation per Blue Cross of Idaho/Healthcare Operations (BCI/HCO) workflows, policy and procedures.
• Review and work designated reports and programs as assigned.
• Assure compliance with company/department policies & procedures and member and provider contract requirements.

Additional skills that we are looking for:

• Good verbal and written communication skills
• Medical terminology
• Familiar with ICD10 and CPT coding
• Problem Solving

Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

This job has expired.