Utilization Management Intake - Associate II

UST; Taguig; On-site; PHP 201,000 - 357,000; Full time

Job summary

UST in Manila is seeking a healthcare BPO professional to support Utilization Management operations. You will interact with nurses, insurance adjusters and other healthcare professionals to process referrals and case assignments.

The role requires handling faxes, data entry, document scanning and management across multiple applications, with attention to detail and teamwork. If you are organized, able to multitask, and have at least six months in healthcare BPO, this position offers a stable

Qualifications

• Any college education.
• At least 6 months of Healthcare BPO work experience.
• Ability to multitask across multiple applications.
• Strong analytical skills with excellent attention to detail.
• Team player with excellent interpersonal skills.
• Claims experience highly preferred.

Responsibilities

• Interact professionally with Nurses, Insurance Adjusters and other medical professionals.
• Handle intake / data entry of UM referrals and case assignment.
• Evaluate faxes by identifying information and research in the Aerial system to link to opened requests by clinicians.
• Scan, upload and label case documents into the appropriate case files.
• Handle inbound faxes under the Managed Care Folder and ensure proper transmittal of documents to the appropriate queue.
• Collect medical files and documents to be scanned, indexed and uploaded to Utilization Review case management application.
• Separate and sort EMR and documents.
• Determine the correct path for services requested from the received fax and move to the appropriate clinician to review the case.

Skills

Intake

Utilization Management

Claims Management

Healthcare Systems

Business Operations

Medical Records Management

Education

Any college education

Job description

Role Description

• Professional interaction with Nurses, Insurance Adjusters and other medical professionals.
• In-take / Data Entry of UM referrals and case assignment
• Evaluate faxes received by looking for identifying information and through thorough research in the Aerial system, file can be linked to opened requests by the clinicians that is instrumental in their completion of the review process.
• Scan, Uploadand labe case documents into the appropriate case files
• Handle Inbound faxes under the Managed Care Folder and ensure proper transmittal of documents to the appropriate queue.
• Collection of medical files and documents to be scanned, indexed and uploaded to Utilization Review case management application
• Separate and sort EMR and documents
• Properly determine the correct path for the services requested from the received fax and move to the appropriate clinician to review the case i.e. urgent care/non-urgent care that have different timetables/TAT that will impact NCQA

Qualifications

• Any college education
• At least 6 months of Healthcare BPO work experience
• Ability to multitask across multiple applications
• Strong analytical skills with excellent attention to detail
• Team player with excellent interpersonal skills
• Claims experience highly preferred

Skills

• Intake
• Utilization Management
• Claims Management
• Healthcare Systems
• Business Operations
• Medical Records Management