UM / Data Entry Tech

About the role

Principal Accountability

• Screens information received and refers members to the appropriate provider and/or contacts the provider directly for members.
• Facilitates the authorization process for requests that do not require clinical criteria application or judgment.
• Provides relevant information to members and assists them in resolving Plan related problems when Member Services personnel are not available.
• Acts as a resource to staff for questions related to the prior authorization process.
• Refers unresolved prior authorization process questions to the Lead Intake Specialist.
• Assists the Lead Intake Specialist in identifying, planning and implementing staff training programs.
• Identifies and reports member and provider educational opportunities to the Lead Intake Specialist.
• Accurately answers questions regarding Plan benefits and Utilization Management requirements for members and providers.
• Makes appropriate inquiries to determine potential coordination of benefits and advises appropriate provider and claims staff of same.
• Supports Utilization Management nurses with data entry.
• Performs other duties as assigned.
• Adheres to Select Health and KMHP policies and procedures.
• Supports and carries out the Select Health and Mercy Mission & Values.
• Key Competencies/Success Factors: Excellent interpersonal and verbal communication skills.
• Attention to detail and confidentiality.
• Patience and a balanced demeanor.
• Professional image.
• Ability to write clear and concise reports.
• Willingness to work any shift.
• Availability for in-service training.

Requirements

High School Diploma / GED

• Proficient PC Skills in a Windows based environment including word processing, spread sheets and working in database programs.
• Proven ability to keep accurate and timely records and documentation according to established processes
• Experience as a medical assistant or role with similar responsibilities
• Experience handling multiple calls or triaging calls
• Medical Terminology, ICD, CPT, and coding experience

Additional Information

All your information will be kept confidential according to EEO guidelines.