Utilization Review Specialist

Verida Inc; Villa Rica (GA); On-site; USD 23,000 - 24,000; Full time

Job summary

Verida Inc. in Villa Rica, GA is seeking a Full-Time Admin Support Worker to review member transportation requests and ensure adherence to mileage guidelines within Medicaid-related programs.

The role requires 2+ years in healthcare customer service, strong MS Word/Excel skills, and excellent written and verbal communication. You’ll coordinate with internal departments and clients in a high-demand environment.

Qualifications

• High School diploma or equivalent required.
• Minimum 2 years of customer service experience, preferably in healthcare.
• Knowledge of Medicare/Medicaid concepts is a plus.

Responsibilities

• Review and determine approvals/denials for member transportation beyond mileage guidelines.
• Process subscription/Standing Order transportation requests for approved facilities.
• Prepare daily denial letters, no-show letters, and monthly denial summaries.
• Run monthly denial summary reports and communicate with clients.

Skills

Medicare knowledge

Microsoft Word

Microsoft Excel

Communication skills

Multitasking

Analytical thinking

Interpersonal skills

Education

High School diploma or equivalent

2 years of customer service in healthcare

Tools

Microsoft Word

Microsoft Excel

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time Admin Support Worker Villa Rica, GA, US

2 days ago Requisition ID: 2562

Salary Range: $17.00 To $17.50 Annually

Summary: The primary responsibility of this role consists of reviewing member transportation requests that are over the contractual mileage guidelines.

ESSENTIAL FUNCTIONS

• Reviewing and making approval/denial determinations for all member transportation requests that are outside of the geographical mileage guidelines and reviewing requests to non-covered Medicaid services and or locations.
• Review for approval/denial determinations for facilities wishing to participate in the organization’s Subscription/Standing Order Transportation Program.
• Process subscription/Standing order transportation requests from approved facilities for NEMT.
• Investigates transportation provider complaints lodged against Medicaid members during transportation and issuance of Member Warning Letters as warranted.
• Responsible for completing the three departmental reports: daily denial letters, member no-show letters, and monthly denial summary.
• Run Monthly Denial Summary Report for covered regions and send to the client.

Required Skills and Abilities

• Knowledge of Medicare and Medicaid, community resources, dialysis, and the nursing home placement process.
• Must possess entry to mid-level proficiency in Microsoft Word and Excel.
• Excellent written and verbal communication skills.
• Possesses and demonstrates multi-tasking skills in a high-stress environment while working with multiple internal departments, as well as external entities.
• Analytical thinker with good judgment.
• Well-organized, self-directed individual, who is flexible and takes direction well.
• Possesses a high level of interpersonal skills to handle sensitive and confidential situations.

Minimum Required Education/Training

• High School graduate or equivalent.
• 2 years of customer service experience and or employment in the healthcare industry.