Utilization Managment Associate

Job Family:

Medical Assistant

Travel Required:

None

Clearance Required:

None

What You Will Do:

The Utilization Management Assistant's primary responsibilities are to perform selected services and functions related to Utilization Review, under the direction of the Manager and nurses. This includes communicating with insurance companies and other departments in the institution. Under limited supervision, independently provides broad-scale administrative, project and operational support affecting multiple complex departments and/or the organization, which require high level skills and knowledge of departmental and organizational policies and procedures.  Utilizes considerable judgment in interpreting departmental policies to resolve routine to complex inquiries or problems, serves as primary liaison with other departments and agencies.  Develops, recommends, and implements administrative and operational protocols for the department.  Prepares a wide range of documents; composes, edits, and proofreads correspondence & reports; creates and maintains spreadsheets and databases and produces reports; edits and proofreads documents to ensure accuracy. 

Works in collaboration with Utilization Review nurses in activities related to Utilization Review.

Utilization review and Authorizations:

• Address daily requests for clinical review from insurance companies and ensures authorizations are obtained, preventing clinical/administrative denials and to expedite claim payment.

•   Update authorizations daily from Insurance companies received via fax and phone and update in the system in order to track authorizations and provide timely updates to prevent denials

• Review high dollar inpatient accounts on concurrent basis ensuring concurrent reviews and authorizations are in place

• Point person for all insurance nurse reviewers and provider reps, providing and verifying patient information and as requested, per HIPPA policy, in order to facilitate reviewer processes in granting authorization.

• Verify all faxed reviews transmitted successfully-refax if unsuccessful in order to prevent lack of information denials.

• Follow through with verification of insurance coverage, authorized days and benefits as needed for inpatient population.

• Participate as needed as a member of denials management team

• Monitor outcomes of appeals as needed by Denials Team Lead

• Previous healthcare related experience

• Excellent verbal and written communication skills

• Ability to meet deadlines

• Previous experience will Word Products (Excel, Powerpoint)

What You Will Need:

• Minimum of high school diploma or GED equivalent

• 3-4 years previous healthcare experience

What Would Be Nice To Have:

• Knowledge of medical terminology

• Intermediate to advanced Excel and spreadsheet experience

• Strong attention to detail

The annual salary range for this position is $43,000.00-$64,600.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex,