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UM Assistants-Work from Home!BroadPath • New York, New York, United States
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UM Assistants-Work from Home!

BroadPath
  • US
    New York, New York, United States
  • US
    New York, New York, United States
Jetzt Bewerben

Über

Direct message the job poster from BroadPath
BroadPath is excited to announce that we are hiring
Work from Home UM Assistants . This role is responsible for receiving, processing, and accurately entering demographic information for all referral and authorization requests submitted by participating providers via fax or phone. Collaborates with medical management teams and other health plan departments, including Claims and Network Development, to ensure seamless coordination. Provides excellent customer service and education for all incoming calls, addressing questions related to providers or plan products.
Compensation Highlights:
Schedule Highlights:
Training Schedule: 2 weeks, Monday-Friday, 8:00 AM - 5:00 PM CST
Responsibilities
Support to Medical Management Intake Department
Process incoming faxes and phone requests into the intake department
Gather demographic and benefit information and document in the appropriate system following established policies and procedures
Ensure adherence to turnaround times and department standards monitored through quality reviews
Evaluate and route incoming calls and faxes, assigning them to the appropriate staff for further handling
Perform data entry of authorization details into systems and communicate relevant information to the originating physician, facility, or specialist
Apply knowledge of product lines and regulatory requirements in processing authorization requests, including meeting all notification obligations
Eligibility Confirmation
Confirm member eligibility for requested authorizations, including obtaining identification numbers for newborns
Utilize available resources from state agencies, referencing information by phone or online before processing authorizations
Assist with complaints and appeals related to eligibility and claims, documenting information accurately in the utilization management system
Provider and Member Education
Provide guidance to providers on authorization requirements, processes, and health plan policies
Support Member Services and Network Development by communicating and educating on authorization status, processes, and any changes
Maintain ongoing education with provider office staff regarding products and Medicaid services
Discuss availability and accessibility of specialists with providers, assisting and referring issues to appropriate parties as needed
Collaborate with Network Development staff to address provider needs and educational requirements
Internal Collaboration
Receive transfer calls from Member Services regarding authorization questions, issues, or service provider capabilities
Guide and educate providers on submission requirements for SSI authorizations, continued stay authorizations, and documentation timeframes
Work closely with Provider Relations to identify providers in need of education or contracting and monitor trends in out-of-network utilization
Communicate with Claims to provide details on levels of care or issues that may impact claim payments
Qualification
High school diploma or equivalent
Experience in managed care, preferably within a medical management department with exposure to claims and member services
Familiarity with healthcare environments is a plus
Proficient in operating PCs, Windows applications, Word, fax machines, photocopiers, multi-line telephones, and other office equipment
Strong customer service skills and phone etiquette
Ability to manage high call volumes, prioritize tasks, remain flexible, and work effectively as part of a team
Preferred
Some college coursework
Experience with ICD and CPT coding
2+ years in managed care, preferably in medical management, claims, or member services
Experience in healthcare or insurance settings
Diversity Statement
At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!
Equal Employment Opportunity/Disability/Veterans
If you need accommodation due to a disability, please email us at HR@Broad-path.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.
BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law.
Compensation: BroadPath has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.
Seniority level Associate
Employment type Full-time
Job function Health Care Provider
Industries Outsourcing and Offshoring Consulting
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  • New York, New York, United States

Sprachkenntnisse

  • English
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