Utilization Management Support Specialist


Milwaukee, WI
United States

Industry
Healthcare / Health Services
Manages Others
No
Experience Required
Yes
Degree Required
No
Security Clearance Required
No
Employment Type
Employee
Work Schedule
Full-Time

Job Description

 

The Utilization Management Support Specialist provides various critical components necessary to day-to-day operational functions while ensuring proper workflow between the Utilization Management Department, providers and internal departments. The Utilization Management Support Specialist coordinates Continuation of Care orthodontic benefits.

PRIMARY JOB RESPONSIBILITIES:

  • Determine dollar amount, calculate financial responsibility, and enter Orthodontic Continuation of Care cases based on prior claims submitted, submitted explanation of benefits, treatment plan and other supporting documentation.
  • Review, research and respond to inquiries routed via telephone, follow-ups, and email.
  • Investigate and manage orthodontic reimbursement inquiries with Client/Provider Engagement, Claims, and Customer Service departments.
  • Verbally communicate authorization decisions to providers, request additional information when necessary, and appropriately document the phone call in DentaQuest’s system.
  • Coordinate, manage and distribute incoming faxes to facilitate distribution to appropriate parties within the organization.
  • Assemble Ortho CAD (electronic orthodontic requests) submission forms in preparation for review.
  • Prepare and Coordinate general anesthesia/IV requests Organize, coordinate and communicate Outpatient Facility Requests to appropriate State and/or Managed Care Organizations.
  • Process requests received in the Outpatient Facility Specialist queue.
  • Communicate to management ways to improve processes and productivity of company.
  • Adhere to DentaQuest business processes.
  • Assist with administrative and other duties as assigned.
Job Requirements
JOB REQUIREMENTS:

Required:

High School Diploma or equivalent.
1 year experience in clerical setting
Knowledge of general computer software.
Knowledge of telephone systems.
Knowledge of dental terminology.
Typing skills of 30+ wpm.
Ability to read Explanation of Benefits.
Good interpersonal skills.
Ability to work independently.
Good PC Skills.
Excellent verbal communication skills.
Excellent mathematical skills.
Excellent analytical skills.
Good judgment and ability to resolve payment issues.
Ability to prioritize and organize multiple tasks.
Ability to remain organized with multiple interruptions.
Required to attend additional training as requested/deemed necessary.

PHYSICAL DEMANDS:
Incumbent must be able to communicate effectively.
Requires overall light physical effort (up to 25lbs.)
Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal computer).
Ability to travel or move about within and outside serviced facilities required.
Incumbent works primarily in either a private or shared office environment.