Temporary Utilization Review Assistant

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond.  As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community.  Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day.  Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
 

Position Summary
 

The Associate Utilization Review Assistant is responsible for providing non-clinical support to the Utilization Management (UM) Team. This role supports the operation of the UM team through internal and external customer service. eligibility verification, data entry of authorizations/organization determinations (OD), ensuring completeness of information on authorization/OD requests, assisting providers and members, and processing requests per standard work in order to ensure that Utilization Management activities are completed in a timely and accurate manner in compliance with contractual standards set forth by CMS, Tricare, and NCQA.

Job Description

Key Outcomes:

• Available on a phone queue between 8am and 430pm as needed to support the UM nurses as well as to receive authorization requests and answer general authorization questions from members and providers.
• Manages multiple authorization queues by reviewing, screening, entering, and processing authorization requests from members and providers per HMD guidelines/workflows and contractual/regulatory standards. Uploads faxes to the medical management system.
• Produces notifications by letter to members and providers as required by regulation and accreditation standards.
• Manages the notification queue and sends out daily census information to targeted facilities as needed.
• Participates in and contributes to Health Management Department meetings and process improvement initiatives.
• Complies with all contractual requirements and organizational/departmental standards regarding authorizations, clinical reviews, and provider/member communications.
• Other duties as needed, may be cross trained as back-up for other non-clinical areas of HMD as needed

Education/Experience:

• Associates Degree or equivalent education and experience
• 2 years of managed care experience including experience in a call center
• Experience with CPT, ICD-10 and HCPCS coding a plus

Required License(s) and/or Certification(s):

• Medical Assistant Certification a plus

Skills/Knowledge/Competencies (Behaviors):

• Demonstrates an understanding of and alignment with Martin’s Point Values
• Basic knowledge of medical terminology, current healthcare benefits and managed care insurance plans
• Basic knowledge of Microsoft Word and Excel
• Knowledge of CMS and NCQA regulations a plus
• Demonstrated technical skills in use of office systems, electronic heath records, and databases
• Strong organizational skills (ability to prioritize and multi-task in a high-pressure environment while maintaining focus on organizational objectives)
• Ability to take direction from multiple individuals and prioritize tasks appropriately to meet priorities and deadlines
• Ability to handle confidential and sensitive information in a discreet and professional manner
• Communicates effectively with both internal and external customers
• Ability to function independently
• Critical thinking: Can identify root causes and suggest creative solutions
• Takes appropriate initiative while soliciting input/advice appropriately
• Ability to collaborate with all internal departments and staff with dedication to customer satisfaction