Coord, Utilization Mgmt I

Ampcus Inc; Owings Mills (MD); Remote; USD 54,000 - 72,000; Full time

Job summary

Ampcus Inc. is seeking a Coord, Utilization Mgmt I to support Utilization Management teams in Owings Mills, MD. This role offers 100% remote work with the requirement to reside in the DMV region.

The candidate will assist with non-clinical administrative tasks related to pre-service, utilization review, care coordination and quality. Essential duties include benefits verification, authorization management, claims inquiries, and case documentation, plus triaging authorization requests for

Qualifications

• High School Diploma required.
• 3 years experience in health care claims/service areas or office support.
• Two years’ experience in health care/managed care setting or previous work in division.
• Knowledge of CPT and ICD-10 coding.
• Excellent communication, organizational and customer service skills.

Responsibilities

• 35% Performs member or provider related administrative support including benefit verification, authorization management, claims inquiries and case documentation.
• 35% Reviews authorization requests for initial determination or triages for clinical review and resolution.
• 20% Provides general support and coordination services for the department including phone handling, messages, correspondence, information research and problem solving.
• 10% Assists with reporting, data tracking, gathering, and dissemination of information such as Continuity of Care and Peer to Peer reviews.

Skills

Communication

Data entry

Medical terminology

Medical knowledge

Ability to multi-task

Education

High School Diploma

Job description

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.

Job Title

Coord, Utilization Mgmt I

Job Location

Owings Mills, MD

Remote Work

100% remote; however the resource must reside in the DMV.

Top 5 Required Skills

• Communication
• Data entry
• Medical terminology
• Medical knowledge
• Ability to multi-task

Job Description

Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality.

Essential Functions

• 35% Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims inquiries and case documentation.
• 35% Reviews authorization requests for initial determination and/or triages for clinical review and resolution.
• 20% Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
• 10% Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level

High School Diploma

Experience

3 years experience in health care claims/service areas or office support.

Preferred Qualifications

• Two years’ experience in health care/managed care setting or previous work experience within division.
• Knowledge of CPT and ICD-10 coding.

Knowledge, Skills and Abilities

• Ability to effectively participate in a multi-disciplinary team including internal and external participants.
• Excellent communication, organizational and customer service skills.
• Knowledge of basic medical terminology and concepts used in managed care.
• Knowledge of standardized processes and procedures for evaluating medical support operations business practices.
• Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy.
• Ability to pay attention to the minute details of a project or task.
• Experienced in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point.

Equal Opportunity Employer

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.