Utilization Management Rep I

Mindlance; City of Albany (NY); On-site; USD 32,000 - 35,000; Full time

Job summary

Mindlance is seeking a candidate based in Albany, NY to coordinate cases for precertification and prior authorization review. The role includes managing incoming claims, determining eligibility, and conducting clinical screenings.

Ideal candidates should have a high school diploma and previous customer service experience. Training will be provided for specific tasks, and it is preferred to have experience in medical terminology and the insurance field.

Qualifications

• Requires high school diploma and 1 year of customer service or call-center experience.
• Proficient analytical, written, and oral communication skills.
• Preferred experience in medical terminology and medical/insurance field.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Manage incoming calls and claims work for contract eligibility.
• Conduct clinical screening process and authorize sessions.

Skills

Customer service experience

Analytical skills

Communication skills

Education

High school diploma

Job description

Job Description

Client Location : 11 Corp. Woods Blvd. Albany NY 12211

Contract Duration : 06+ months contract position

Work Timings : Training 8:30 - 5 and work schedule 10:30 - 7.

Pay rate : $ 16.25 /hr

SUMMARY: Responsible for coordinating cases for precertification and prior authorization review.

MAJOR JOB DUTIES AND RESPONSIBILITIES: Primary duties may include, but are not limited:

Managing incoming calls or incoming post services claims work. Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests. Refers cases requiring clinical review to a Nurse reviewer. Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate. Responds to telephone and written inquiries from clients, providers and in-house departments. Conducts clinical screening process. Authorizes initial set of sessions to provider. Checks benefits for facility based treatment. Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Qualifications

• Requires High school diploma; 1 year of customer service or call-center experience; proficient analytical, written and oral communication skills; or any combination of education and experience, which would provide an equivalent background.
• Medical terminology training and experience in medical or insurance field preferred.

Additional Information

We are looking for a candidate, who have experience in calls handling and customer service. If you are interested feel free to reach Priti Kumari on 732-847-2541.