Member Utilization Representative

New!

Carenational Newbury Park , CA 91320

Posted Today

Member Utilization Representative - Health Plan
Thousand Oaks, CA

This is a Full-Time, Benefits Available, CONTRACTopportunity,expected to last 2 months, or longer!

Member
Utilization Representative (Inbound Calls)

Job Summary:

  • The role of the Member Utilization Representative is to assist Utilization Review nurses by screening Prior Authorization and coordination of specialized services requests, including a broad range of requests for inpatient, outpatient and ancillary services.
  • The purpose of the Prior-Authorization, or Pre-Certification, process is to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to Prior Authorization requests.
  • The Prior Authorizations Specialist is essential to ensuring that prior authorization requests are completed in a timely fashion to meet contractual requirements.
  • Maintains current knowledge of network resources for linking member and provider needs.
  • Authorizes certain specified services, under the supervision of the manager and according to established departmental guidelines.
  • Per standard workflows, forwards specified requests to the clinician for review and processing.
  • Additionally, the Specialist answers inbound calls from providers and other departments and redirects, as needed.
Member Utilization Representative Background:
  • Requires an education level of at least a high school diploma or GED.
  • 1-2 years customer service experience.
  • Strongly prefer around 1 year experience in a call center settingor phone support role.
  • Any healthcare experience is a plus.
  • Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
  • Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
  • Must test at a minimum of 35 wpm typing with a high level of accuracy.
  • Basic computer literacy (MS Office) and typing skills are necessary.
#ADMIN
See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Accounts Receivable Representative
New!

Targetcw

Posted Today

VIEW JOBS 11/21/2018 12:00:00 AM 2019-02-19T00:00 <strong>Accounts Receivable Representative<br /> Thousand Oaks, CA 91320</strong><br /> <strong>M-F, flexible between 7am- 5:30pm</strong><br /> <b>Contract to Hire</b><br /> <strong>Pay: $15-$17.50 per hour</strong><br /> <strong>Standard Background Check</strong><br /> <strong>Targeted Start: ASAP</strong><br /> <br /> <strong><u>Job Description</u></strong> <ul style="list-style-type:circle;"> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Research and re-bill unpaid claims</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Research and resolve accounts appearing on Follow-up Reports.</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Make appropriate decisions and calls to carriers to maximize reimbursement on accounts to be worked. </li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Correct all errors on electronic error reports using all available information.</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Meet production and quality standards.</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Assists in identifying current and/or potential billing issues specific to outstanding receivable</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Presenting data to appropriate parties and partnering to develop resolutions</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Participates in daily production assignments that will continue to develop understanding and knowledge of processing guidelines and expectations of respective client(s) payer mix</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Ability to take patient phone calls and assist Customer Service when business needs arise</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Assist in other duties as assigned</li> </ul>  <br /> <strong><u>Job Requirements</u></strong> <ul style="list-style-type:circle;"> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">High School Diploma or equivalent</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">A/R & Medical billing experience preferred</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Medical office experience required</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Proficient with computer / data entry skills</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">MS Office experience (Outlook, Word, Excel)</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Attentive to detail</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Possess analytical and problem-solving skills</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Strong written and oral communication skills</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Represents the office/Organization in a positive manner; supports and encourages strong morale and spirit in his/her team.</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Works well with others and little supervision needed</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Must maintain patient/client confidentiality</li> <li style="padding: 0; margin: 0;" style="padding: 0; margin: 0;">Communication skills sufficient to relay information to physicians, insurance providers and patients with clarity and conciseness</li> </ul> Please send your resume in a PDF or Word format for immediate consideration.<br />  <br />   Targetcw Thousand Oaks CA

Member Utilization Representative

Carenational