Utilization Management Representative - Remote

About the role

Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

Responsibilities

• Data entry of UR and/or Pop Health requests, admissions and discharge dates for inpatient services; address post-acute discharge needs into EPIC; address into the system including pre-cert for OB patients
• Completion of clerical support tasks including incoming and outgoing fax requests, Xeroxing and filing, general mail support and correspondence received; generate reports for specific tasks (i.e. bed day)
• Collaborate with external and internal customers to coordinate delivery of services and discharge planning as needed; including but not limited to making appointments, contacting patients regarding various issues, coordinating services between providers, payors and patients
• Obtain authorizations from health plan for POS internal referrals and other services
• Verify benefit interpretation and other communication from payors are entered into Kelsey-Seybold system
• Serve as resource to clinic physicians, staff, payors and patients regarding pre-certification issues
• Provide your feedback on BizChat

Requirements

• High School diploma or GED from an accredited program
• Valid Texas driver's license
• 2+ years of managed care experience either in a physician office or hospital setting, health plan, ACO, or other managed care setting
• Knowledge of medical terminology, HMO, PPO and referral processes
• Alpha/numeric data entry and basic PC literacy
• Proven excellent communication skills
• Proven excellent time management skills

Qualifications

• College level courses
• Epic System usage
• Knowledge of CPT & ICD 10 Coding methodologies

Skills

• Data entry
• PC literacy
• Communication skills
• Time management skills

Benefits

If you are located in Texas, you will have the flexibility to work remotely*. As you take on some tough challenges, this position follows a hybrid schedule with three in-office days per week.

Pay

The hourly pay for this role will range from $16 - $29 per hour based on full-time employment. We comply with all minimum wage laws as applicable.