Utilization Management Representative I
| Company | Elevance Health |
|---|---|
| Location | Indianapolis, IN, USA, Louisville, KY, USA, Columbus, GA, USA, Atlanta, GA, USA, Cincinnati, OH, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | |
| Experience Level | Entry Level/New Grad, Junior |
Requirements
- HS diploma or GED
- Minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
Responsibilities
- Managing incoming calls or incoming post services claims work.
- Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
- Refers cases requiring clinical review to a Nurse reviewer.
- Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
- Responds to telephone and written inquiries from clients, providers and in-house departments.
- Conducts clinical screening process.
- Authorizes initial set of sessions to provider.
- Checks benefits for facility based treatment.
- Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Preferred Qualifications
- Medical terminology training and experience in medical or insurance field preferred.