Utilization Management Support Specialist

What are important things that YOU need to know about this role?

• Experience:
  
  SQL experience is required. Candidates should be highly detail-oriented and able to work independently with minimal supervision.

• Schedule:
  
  Standard hours are 8:00 AM to 5:00 PM CT. Participation in a holiday and weekend coverage rotation is required.

• Work Location:
  
  This is a fully remote, permanent work-from-home position.

Utilize internal practices and policies to perform regular audits of authorization case work performed by the administrative and clinical team. Provide administrative set up and technical support for authorization processing to ensure authorization service level agreements (SLAs) are met in accordance with contractual obligations and in compliance with regulatory requirements.

Assist in determining root cause of quality issues and processing errors and recommend and implement appropriate solutions/controls to eliminate future errors.

• Perform daily audits of authorization turnaround times to ensure compliance is met, coordinating completion when necessary.
• Perform monthly (more frequent when needed) audits of authorizations worked by Authorization Support Representatives for quality and accuracy.
• Communicate with management and other internal staff on audit findings and provide any appropriate process change recommendations.
• Work with the UMAnalyst to resolve any processing issues leading to audit concerns. and recommend and implement appropriate solutions/controls including support of SKYGEN’s Internal Priority Quality Initiative (IPQI) processes and post implementation monitoring.
• Provide technical assistance to the clinical and administrative team to include, but not be limited to: system set up, attachment vendor set up, and day to day troubleshooting.
• Aid in configuration and auditing of authorization set up in the Enterprise System.
• Create and run SQL scripts to monitor SLA adherence and aid in authorization processing.
• Maintain current knowledge of Utilization Management/Authorization policies and procedures, URAC and NCQA standards.

• Required Level of Education, Licenses, and/or Certificates
  • High school diploma or equivalent
• Required Level of Experience
  • 2 plus years of job related experience
• Required Knowledge, Skills, and Abilities
  • Excellent Computer literacy including strong proficiency in Microsoft Office
  • Ability to remain organized with multiple interruptions
  • Excellent ability to organize work appropriately ensuring deadlines are met
  • Excellent communication skills including both internal and external customers
  • High attention to detail and accuracy
  • Strong problem solving skills to allow for the correct diagnosis of a problem along with potential solutions for resolution.
  • Some knowledge of/prior use of SQL

• Preferred Level of Education, License, and/or Certificates
  • Associates Degree/2 year degree or Bachelor’s degree
• Preferred Level of Experience
  • Two or more years in a quality role
  • Experience with healthcare terms
• Preferred Knowledge, Skills, and Abilities
  • Knowledge of dental and vision claims payment and billing processes
  • Knowledge of general practices for appeals, complaints, and grievances handling
  • Knowledge of federal and state regulations as it pertains to health care compliance
  • Holds Enterprise System Certification(s)

The hourly pay range and midpoint is listed below for your reference. Please keep in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration when determining placement within the range.

Compensation Range: $21.68 - $31.08

Compensation Midpoint: $27.08