Utilization & Authorization Specialist

Harris Health; Houston (TX); On-site; USD 42,000 - 64,000; Full time

Job summary

Community Health Choice, Inc. is seeking a UM Coordinator to assist CHC Providers with authorization processes, data entry in the Utilization Module, and support services that do not require clinical decisions.

You will handle admissions, transfers, home health, and durable medical equipment requests, and help ensure regulatory timelines and CHC guidelines. Ideal candidates have at least three years of referrals/authorization experience, insurance experience in a managed care environment, and

Qualifications

• High School or equivalent education; some college preferred.
• Three (3) years of referrals/authorization experience.
• At least one (1) year insurance related experience in managed care environment.
• Experience in medical coding preferred.
• Proficiency with Microsoft Office (Word, Excel, Outlook).

Responsibilities

• Assists in monitoring reports and refers to UM Nurse or Manager.
• Data entry of requests for authorization for admissions, notification of deliveries, sick newborns, and other services.
• Answers provider hotline calls in a timely and professional manner.
• Forwards calls to appropriate nursing or medical staff and other departments as needed.
• Contributes to departmental goals and process improvement plans.

Skills

Attention to detail

Communication skills

Data entry

Education

High School diploma or equivalent

Some college coursework

Tools

Microsoft Word

Microsoft Excel

Job description

Community Health Choice, Inc. is seeking a UM Coordinator to assist CHC Providers with authorization processes, data entry in the Utilization Module, and support services that do not require clinical decisions.

You will handle admissions, transfers, home health, and durable medical equipment requests, and help ensure regulatory timelines and CHC guidelines. Ideal candidates have at least three years of referrals/authorization experience, insurance experience in a managed care environment, and