Coord, Utilization Mgmt I

Lumen Solutions Group Inc

Washington, DC

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JOB DETAILS

JOB TYPE

Full-time

SKILLS

Administrative Skills, Business Practices, Communication Skills, Cross-Functional, Current Procedural Terminology (CPT), Customer Support/Service, Data Collection, Desktop Administration, Desktop Virtualization, Detail Oriented, Diversity, Documentation, Healthcare, High School Diploma, ICD-10, Internet Technology, Laptop PC, Managed Care, Medical Office Administration, Medical Terminology, Medical Treatment, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Microsoft Word, Operational Audit, Organizational Skills, Problem Solving Skills, Quality of Care, Software Administration, Telephone Skills, Time Management, Utilization Management

LOCATION

Washington, DC

POSTED

5 days ago

Job Description: PURPOSE: Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality of care. This position will require the individual to work thirty-two hours during the business week and eight hours on weekends. ESSENTIAL FUNCTIONS: 35% Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims inquiries and case documentation. 35% Reviews authorization requests for initial determination and/or triages for clinical review and resolution. 20% Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems. 10% Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education Level: High School Diploma Experience: 3 years experience in health care claims/service areas or office support. Preferred Qualifications Two years experience in health care/managed care setting or previous work experience within division Knowledge of CPT and ICD-10 coding. Knowledge, Skills and Abilities (KSAs) Ability to effectively participate in a multi-disciplinary team including internal and external participants., Proficient Excellent communication, organizational and customer service skills. , Proficient Knowledge of basic medical terminology and concepts used in managed care., Proficient Knowledge of standardized processes and procedures for evaluating medical support operations business practices., Proficient Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy. , Proficient Ability to pay attention to the minute details of a project or task, Proficient Experienced in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point, Proficient The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. Additional Skills: Guiding Care, Facets, Nice Administrative Organizational Skills No 1 Intermediate Currently Using 2 - 4 Years Healthcare Healthcare Experience No 1 Intermediate Currently Using 2 - 4 Years Healthcare ICD 10 No 1 Intermediate Currently Using 2 - 4 Years Miscellaneous FACETS No 1 Intermediate Currently Using 2 - 4 Years ***Lumen and / or its clients will not provide equipment (Laptop, monitor, etc.) to the selected contractor. The contractor must have their own equipment. Access to a virtual desktop set up (software) will be provided by Lumens client, allowing the user access to the required systems and technology.*** Lumen Solutions Group Inc. is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

About the Company

Lumen Solutions Group Inc

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