Um Prior Auth Specialist

Job Category:
Clerical/Administrative Support

Integral member of the Utilization Management (UM) team. Supports UM processes through accurate and timely notification of admission and communication of clinical review information to insurance companies. Strong, clear, and effective communication, excellent customer service, organization, time management, and computer skills are imperative in this role. Collaborates and coordinates with members of the UM and Revenue Cycle teams to ensure timely and efficient delivery of required workflow, services and tasks to result in:

• Support of positive patient health care outcomes
• Increased patient/health care team outcomes and satisfaction
• Improved communication, awareness, and adherence to regulatory requirements associated with utilization
• Support for appropriate level of care and decreased inpatient bed day denials
• Appropriate and timely authorization for level of care
• Decreased denials

High School Graduate or Equivalent.

• At least two (2) years of administrative/office/clinical support/managed care or utilization management, healthcare experience.
• Prefer experience with managing insurance authorizations and interaction with payers.
• Medical Terminology, prefer
• Prefer experience with ICD 10