Clinical Support Specialist - Utilization Mngmt
Qualifications:
- Associate or High School Diploma degree required.
- Health care delivery, medical billing, coding and/or customer service experience.
- Knowledge of utilization management process (i.e., Health Center, Hospital, Insurance Company, Physician office)
- Knowledge of Utilization Management regulations and standards
- Experience with Medicare, Medicaid, and Commercial lines of business
- bilingual preferred.
shift: First
work hours: 8 AM - 4 PM
education: High School
Responsibilities- Provide support to UM Care Managers to ensure provider and member customer satisfaction.
- Process authorizations and referrals using desktop procedures and workflows
- Outreach providers for needed clinical information and upload to appropriate authorization in Mass General Brigham Health Plans’ online provider portal
- strong knowledge and understanding of processing requests per Medicare, Medicaid, andcommercial lines of business
- Meet quality standards per NCQA, CMS, DOI, and health plan regulations
- Ensure customer satisfaction to providers and members
- Respond in a timely and accurate manner to internal and external customer inquiries as per policies and procedures. Escalate urgent issues as appropriate.
- Achieve and maintain compliance with telephone accessibility
- Authorizations
- Referrals
- Medical Billing
- medical coding
- utilization management
- medicare/medicaid
- Spanish
- Years of experience: 0 years
- Experience level: Entry Level
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Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility).
This posting is open for thirty (30) days.