Utilization Review Intake Specialist

Overview

Now is the time to join us!

We're Personify Health. We're the first and only personalized health platform company to bring health, wellbeing, and navigation solutions together. Helping businesses optimize investments in their members while empowering people to meaningfully engage with their health. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we're shaping a healthier, more engaged future.

Responsibilities

Who are you?

Level I:

• Perform clerical/administrative duties in the utilization management division

• Answer and route all incoming phone calls

• Provide accurate information to internal and external customers regarding pre-certification process, including gathering demographic, non-clinical, and/or provider data for pre-certification via phone, fax, inter/intranet, and various computer software programs

• Review service requests and manage the requests as efficiently as possible involving the appropriate department as needed

• Perform data entry and maintain complete documentation of case information; assist in document maintenance or revisions; compile monthly reports; maintain logs and files

• Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis

Level II:

• Perform advanced clerical/administrative duties in the utilization management division

• Same as level I with additional expectations and trainings in this division

• Demonstrate a higher level of customer service and understanding of the job

• Serve as a group expert and how to research information on a group

Senior:

• Serve as a mentor and perform advanced clerical/administrative duties in the utilization management division

• Assist with planning, organization and distribution of work; keep team informed of updates and changes in policy or procedure.

• Provide support to lead and efficiently act as backup to lead their duties

• Assist in special projects, process updates and implementation

• Train and mentor new and existing intake staff, update, and develop training material as needed

KEY COMPETENCIES:

Level I

• Strong written and verbal communication skills

• Ability to manage high volumes of customer service calls

• Proficient in Microsoft Excel, Word and Outlook

• Ability to organize, prioritize, and multitask in a fast-paced/deadline driven environment

• Demonstrate ability to work independently with excellent judgment

• Accurate data entry skills (40wpm)

• Knowledge of medical terminology; ICD-10, CPT & HCPCS coding desirable

Level II

• Require at least 3-5 years working in the insurance field in a similar environment

Senior

• Require greater than 5 years working in the insurance field in a similar environment

• Teaching and mentoring skills education or experience to provide guidance to staff

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Qualifications

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

Level I-II

• Prior experience in customer service and/or medical background

• Prior insurance and/or claims background

• Prior experience in a medical front office or hospital patient intake, medical claims processing, or an equivalent combination of education and experience

• Associate degree preferred in business, management, or related field

Senior

• Prior experience at HC in customer service and/or claims background 2-3 years

• Working at Level II minimum 2 to 3 years with mentoring new hires.

• Additional education can be considered

• Additional proficiencies in Microsoft suite and Smartsheet with data analytics critical thinking

• Physical and Mental Requirements:

• Ability to safely and successfully perform the essential job functions with or without a reasonable accommodation, including meeting qualitative and/or quantitative productivity standards.

• Ability to maintain regular, punctual attendance.

• Ability to sit for 6-8 hours.

• Constant use of computer keyboard and mouse; repetitive use of both hands.

• Occasional to frequent twisting of neck; frequent bending of neck and at waist

No candidate will meet every single desired qualification. If your experience looks a little different from what we've identified and you think you can bring value to the role, we'd love to learn more about you!

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position is up to $35,000. Note that salary may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.