Utilization Management Coordinator - I

Ampcus, Inc; Reston (VA); On-site; USD 45,000 - 65,000; Full time

Job summary

A global consulting firm located in Reston, VA, is seeking a highly motivated Utilization Management Coordinator - I to support the clinical teams with administrative tasks related to pre-service utilization review and care coordination. The ideal candidate should have strong analytical and communication skills, knowledge of medical terminology, and experience in a healthcare setting with at least 3 years in related roles. This position offers an opportunity to work in a collaborative environment with a focus on quality of care.

Qualifications

• Ability to effectively participate in a multidisciplinary team.
• Knowledge of basic medical terminology and concepts used in managed care.
• Ability to pay attention to minute details.

Responsibilities

• Performs member or provider related administrative support.
• Reviews authorization requests for initial determination.
• Provides general support and coordination services for the department.

Skills

Strong analytical skills

Electronic efficiency

Excellent communication skills

Organizational skills

Customer service skills

Education

High School Diploma

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

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: Utilization Management Coordinator - I.
Location: Reston, VA.

Purpose:

• 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 of care.

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.

Top 5 Required Skills:

• Strong analytical skills.
• Electronic efficiency.

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 accommodation may be made to enable individuals with disabilities to perform the essential functions.

Knowledge, Skills and Abilities (KSAs):

• Ability to effectively participate in a multidisciplinary 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.
• Experience in the use of web-based technology and Microsoft Office applications such as Word, Excel, and PowerPoint.
• 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.

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.