Utilization Management Assistant


Buffalo, NY

What you'll be doing

The UMA provides administrative support to the utilization management, behavioral health and case management departments. The UMA is the first line of review in the UM prior authorization process, reviewing for eligibility and benefit. The UMA is responsible for intake of clinical information, data entry of requests, preparation of the documents for clinical review and/or administrative review per standard operating procedures and various other tasks in support of initiatives and programs. The UMA is accountable for maintaining departmental productivity and quality metrics and completing assigned tasks in compliance with regulatory, departmental requirements and other duties as needed.

What your background should be

Two (2) years of medical office and/or data entry experience may be considered in lieu of degree. Minimum of one (1) year of medical office experience required. Utilization management experience preferred. Solid verbal, written and interpersonal communication skills required. Demonstrated customer service skills and proficiency in data entry required. Excellent organization skills with attention to detail and follow through. Ability to meet and/or exceed all established performance standards on a consistent basis (i.e., regulatory timeframes, accuracy and quality). Demonstrate proficiency with PC navigational skills. Power, MHS and Siebel experience preferred. Knowledge of medical billing procedures, CPT and ICD-9 coding preferred. Ability to work flexible hours and/or overtime as needed. Proven examples of displaying the IH values: passion, caring, collaborative, respectful and accountable. Maintains confidentiality and uses only the minimum amount of protected health information (PHI) necessary to accomplish job related responsibilities.

Required Schooling / Training

Associates degree required.

Who is the client company

The company provides a wide variety of health plans and services.
If you are interested in this position, send your resume to apply@kochdavis.com