UM Assistants-Work from Home

Direct message the job poster from Broad Path

Broad Path is excited to announce that we are hiring Work from Home UM Assistants
. This role is responsible for receiving, processing, and accurately entering demographic information for all referral and authorization requests submitted by participating providers via fax or phone. Collaborates with medical management teams and other health plan departments, including Claims and Network Development, to ensure seamless coordination. Provides excellent customer service and education for all incoming calls, addressing questions related to providers or plan products.

Compensation Highlights:

Schedule Highlights:

Training

Schedule:

2 weeks, Monday-Friday, 8:00 AM - 5:00 PM CST

Responsibilities

Support to Medical Management Intake Department

• Process incoming faxes and phone requests into the intake department
• Gather demographic and benefit information and document in the appropriate system following established policies and procedures
• Ensure adherence to turnaround times and department standards monitored through quality reviews
• Evaluate and route incoming calls and faxes, assigning them to the appropriate staff for further handling
• Perform data entry of authorization details into systems and communicate relevant information to the originating physician, facility, or specialist
• Apply knowledge of product lines and regulatory requirements in processing authorization requests, including meeting all notification obligations

Eligibility Confirmation

• Confirm member eligibility for requested authorizations, including obtaining identification numbers for newborns
• Utilize available resources from state agencies, referencing information by phone or online before processing authorizations
• Assist with complaints and appeals related to eligibility and claims, documenting information accurately in the utilization management system

Provider and Member Education

• Provide guidance to providers on authorization requirements, processes, and health plan policies
• Support Member Services and Network Development by communicating and educating on authorization status, processes, and any changes
• Maintain ongoing education with provider office staff regarding products and Medicaid services
• Discuss availability and accessibility of specialists with providers, assisting and referring issues to appropriate parties as needed
• Collaborate with Network Development staff to address provider needs and educational requirements

Internal Collaboration

• Receive transfer calls from Member Services regarding authorization questions, issues, or service provider capabilities
• Guide and educate providers on submission requirements for SSI authorizations, continued stay authorizations, and documentation time frames
• Work closely with Provider Relations to identify providers in need of education or contracting and monitor trends in out-of-network utilization
• Communicate with Claims to provide details on levels of care or issues that may impact claim payments

Qualification

• High school diploma or equivalent
• Experience in managed care, preferably within a medical management department with exposure to claims and member services
• Familiarity with healthcare environments is a plus
• Proficient in operating PCs, Windows applications, Word, fax machines, photocopiers, multi-line telephones, and other office equipment
• Strong customer service skills and phone etiquette
• Ability to manage high call volumes, prioritize tasks, remain flexible, and work effectively as part of a team

Preferred

• Some college coursework
• Experience with ICD and CPT coding
• 2+ years in managed care, preferably in medical management, claims, or member services
• Experience in healthcare or insurance settings

Diversity Statement

At Broad Path, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!

Equal Employment Opportunity/Disability/Veterans

If you need accommodation due to a disability, please email us at  This information will be held in confidence and used only to determine an appropriate accommodation for the application process.

Broad Path is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law.

Compensation:
Broad Path has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Associate

Full-time

Health Care Provider

Outsourcing and Offshoring Consulting