Specialist, UM Administrative

OhioGuidestone; Berea (OH); On-site; USD 38,000 - 54,000; Full time

Benefits offered by this job

Stable nonprofit with 160+ year track

10 paid holidays

Flexible work schedules

401(k) with employer match

Employee Assistance Program (EAP)

Recognition and rewards

Job summary

OhioGuidestone in Ohio is seeking an Administrative Specialist to support the Billing department. You will receive, review, and route authorization and utilization management requests, verify information, and enter data into internal systems to keep workflows moving smoothly.

This role requires a high school diploma (associate or bachelor preferred) and 1–3 years in healthcare administration or related fields.

Qualifications

• High school diploma or GED required; higher degree preferred.
• 1–3 years of experience in healthcare administration or related fields.
• Experience with EMR, health plan, authorization, or case-management systems preferred.
• Proficient with technology including EHRs and Microsoft Office.

Responsibilities

• Provide administrative and operational support to the Billing department.
• Receive, review, and route authorization and utilization management requests.
• Verify member, provider, authorization, and service information for completeness and accuracy.
• Enter and maintain authorization data in internal systems.
• Monitor requests and cases to ensure information and deadlines are met.
• Prepare reports, spreadsheets, and status updates for Utilization Management.

Skills

Tech proficient

Interpersonal skills

Independent and collaborative

Flexible scheduling

Education

High school diploma or GED

Associate or bachelor's degree preferred

Tools

Electronic Medical Records (EMR) systems

Microsoft Office Suite

Job description

OhioGuidestone provides a complete continuum of responsive person-centered prevention services, mental health and substance use treatment, and wrap-around supports, serving the needs of over 50,000 people each year through telehealth and locations across Ohio.

At OhioGuidestone, we believe a workforcecomprisedof employees from diverse backgrounds andcommunitiesand a culture of belonging makes us a better organization. Together, we continue to build a workplace that encourages, supports, and celebrates the varied voices of our employees.

Essential Functions:

• Demonstrate the values and guiding principles of OhioGuidestone every day, performing with the highest standards of excellence, integrity and ethics.
• Provide administrative and operational support to the Billing department.
• Receive, review, and route authorization and utilization management requests to the appropriate department or clinical reviewer.
• Verify member, provider, authorization, and service information for completeness and accuracy.
• Enter and maintain authorization and related information in designated internal systems.
• Monitor requests and cases to ensure required information is obtained and established deadlines are met.
• Request missing documentation from provider offices, health plan staff, and/or internal departments.
• Communicate with providers, members, health plan staff, and internal teams regarding administrative aspects of authorization requests.
• Track pending, approved, denied, and incomplete requests and provide appropriate follow-up.
• Maintain accurate records and documentation in accordance with department procedures, organizational policies, and applicable regulatory requirements.
• Prepare reports, spreadsheets, and status updates related to Utilization Management activities.
• Identify administrative issues, discrepancies, missing information, or delays and escalates concerns appropriately.
• Follow established workflows, policies, regulatory requirements, and confidentiality standards.
• Assist clinical reviewers and department leadership with administrative tasks, projects, and other duties as assigned.
• Maintain productivity, accuracy, and quality standards established by the department.
• Exhibit positivity, flexibility and a willingness to take on new responsibilities as requested or required.
• Demonstrate positive leadership, promote a team-based work environment and a culture of belonging.
• Present the Agency in the most positive light with all internal and external contacts.

Education & Experience:

• High School Diploma or GED required.
• Associate or bachelor's degree preferred.
• 1–3 years of experience in healthcare administration, insurance, medical office operations, prior authorization, claims, utilization management, or a related field preferred.
• Experience with electronic medical records, health plan, authorization, or case-management systems preferred.

Qualifications:

• Mission driven; strong desire to make an impact
• Proficient with technology, including dispatch systems, electronic health records (EHRs), and Microsoft Office Suite.
• Ability to work both independently and collaboratively within a fast-paced environment.
• Effective interpersonal skills; able to speak effectively with individuals and/or groups of people
• Flexible; able to work days, evenings, and/or weekends, as desired to meet the needs of clients

What we offer

• Stable non-profit organization with160+ yeartrack record!
• 10 paid holidays (some are exchangeable)
• Flexible work schedules to support work/life balance
• 401(k) with employer matchoption
• Employment Assistance Program (EAP)
• Recognition and rewards

Wealsocare about the health and safety of our employees. OhioGuidestone requires applicants to complete a pre-employment screening process upon receipt of an offer of employment. Werequireand cover the cost of fingerprint background screening, physical, Tuberculosis test, and drug screen after an employment offer is made. Any employment offer is contingent upon receipt of all satisfactory pre-employment screenings.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.