Pre-Authorization Assistant — UM Support & Enrollee Help

30030 Health Services for Children with Special Needs, Inc.; United States; On-site; USD 27,000 - 45,000; Full time

Job summary

Health Services for Children with Special Needs, Inc. (HSCSN) is seeking an Utilization Management Support Specialist in Washington, DC to assist UM Review staff.

You will manage the department's main phone line, route calls, create authorization shells, and attach relevant documents to the HSCSN electronic record. The role requires a high school diploma (associate degree preferred), 2 years in managed care, strong knowledge of medical terminology, and excellent written and verbal communication.

Qualifications

• High School Diploma or GED required.
• Associate's Degree preferred.
• 2 years related experience in managed care preferred.
• Knowledge of medical terminology.
• Strong written and oral communication skills.

Responsibilities

• Obtains clinical information required for review and documentation of precertification requests and routes to the appropriate individuals for processing.
• Monitors fax machines, faxes queues, and mail for authorization/reauthorization requests and routes information to the appropriate individuals promptly.
• Receives calls from enrollees and providers, assesses nature of call and completes requests.
• Answers inquiries from enrollees/caregivers and providers, and routes to appropriate review nurse or Chief Medical Officer.
• Enters authorizations and/or provides service authorizations to vendors as requested by clinical staff.
• Communicate authorization information to vendors timely and accurately.
• Documents all relevant information and communication in the HSCSN IT system.

Skills

Medical terminology

Team collaboration

Written and verbal communication

Organization

Microsoft Office

Education

High School Diploma or GED

Associate's Degree

Tools

HSCSN EMR system

Job description

Health Services for Children with Special Needs, Inc. (HSCSN) is seeking an Utilization Management Support Specialist in Washington, DC to assist UM Review staff.

You will manage the department's main phone line, route calls, create authorization shells, and attach relevant documents to the HSCSN electronic record. The role requires a high school diploma (associate degree preferred), 2 years in managed care, strong knowledge of medical terminology, and excellent written and verbal communication.