[Hiring] Utilization Management Administrative Support @Avesis

Role Description

The Utilization Management Administrative Support role is crucial in assisting various departmental functions. This position ensures that email requests from provider offices are handled promptly and efficiently. Responsibilities include:

• Collecting missing information from offices necessary for claims processing.
• Assisting in the creation of correspondence for providers and members.
• Including documentation to the requests for the clinical processors to make appropriate decisions.
• Driving the workflow and efficiency of the entire department.

The UM (Utilization Management) Department supports our clients and company through utilizing clinical criteria to approve or deny a service based on the authorization. The UM department plays a crucial role in ensuring that healthcare services provided to members are appropriate, efficient, and effective.

In this role, detail matters, and you will assist in data entry and communication required by the Utilization Management Department involving correspondence for enrollees and providers. You will ensure that entry and manual creation of these ad hoc notifications are completed in a timely manner and meet federal, state, NCQA, or contractual requirements.

Qualifications

• High School Diploma or GED is required.
• Proficiency in accurate data entry, with minimal to no errors.
• Exceptional reading and writing with the ability to communicate at a professional level appropriately at all levels of the organization.
• Strong organizational and time-management skills, with the ability to manage multiple tasks and priorities effectively.
• Ability to think analytically and make independent decisions.
• Ability to meet or exceed quality, accuracy, and production standards as determined by Avēsis.
• Internet & Workspace: A reliable internet connection (25 MBPS upload/50 MBPS download speed) and an appropriate workspace are essential for success in this remote role.

Requirements

• Self-Motivation & Organization: Must be self-motivated and highly organized with the ability to work autonomously without direct supervision.
• Flexible Hours: Work hours will be determined by your manager and may vary based on location, department needs, and workflow. Mandatory overtime may be required during peak seasons.
• Deadline Adherence: Expected to meet established deadlines and deliver high-quality work consistently.
• Virtual Collaboration: Use virtual platforms like Teams and Microsoft Outlook for collaboration. Participate in regular monthly check-ins and bi-weekly department touch bases for market updates and team alignment.
• Confidentiality: Maintain strict confidentiality of information related to Avēsis and its customers, following our information security policies.
• Perform outreach to providers for correction and resubmission if a request is submitted with insufficient information.
• Create ad-hoc manual letter requests utilized to communicate with an enrollee and/or provider.
• Handle clerical support for the department, including receipt and response of incoming and outgoing fax, email transmissions both internal and external.
• Support UM leadership and Avēsis’ communication team in the review and routine maintenance of letter template library for accuracy.
• Light travel and delivery to local post office to ensure same day mailing for urgent mailings.
• Other duties as assigned.

Benefits

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
• Competitive compensation package.
• Excellent medical, dental, supplemental health, life, and vision coverage for you and your dependents with no wait period.
• Life and disability insurance.
• A great 401(k) with company match.
• Tuition assistance, paid parental leave, and backup family care.
• Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
• Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
• Employee Resource Groups that advocate for inclusion and diversity in all that we do.
• Social responsibility in all aspects of our work.