UM / Data Entry Tech

Integrated Resources Inc.; Des Moines (IA); On-site; USD 32,000 - 40,000; Full time

Job summary

A leading healthcare organization is seeking an individual who will assist in the prior authorization process by managing member inquiries and providing support to staff. The role involves excellent communication skills and the ability to handle multitasking effectively. Candidates should have a High School Diploma and experience in a medical setting, contributing to the overall mission of the organization.

Qualifications

• Experience as a medical assistant or similar role required.
• Proficient PC skills and medical terminology knowledge preferred.
• Ability to handle and triage calls effectively.

Responsibilities

• Screens information received and directs members to the appropriate provider.
• Facilitates the authorization process for non-clinical requests.
• Acts as a resource for staff regarding prior authorization.

Skills

Interpersonal communication

Attention to detail

Confidentiality

Patience

Writing concise reports

Education

High School Diploma / GED

Tools

Windows OS

Word processing

Spreadsheet software

Database programs

Job description

• 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/Certifications:

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.