Utilization Management Assistant

Duties :

Primarily responsible for processing initial incoming faxes or phone requests into the intake department

Gathering demographic and benefit data and documenting in appropriate system. This is determined through documented policy and procedures.

• Adheres to time frames, and turn around times, as evidenced by results of inter-rater reliability reviews.
• Routes and evaluates all calls and faxes to refer and assign as necessary to other staff.
• Performs data entry of authorization information into systems, and or fax information to, originating physician and or

facility or specialist.

Implements nuances of product line and regulatory requirements in the processing of all authorization requests including

notification requirements.

Responsible for confirming eligibility for requested authorizations and for requesting membership identification numbers

for newborns.

Utilizes resources available. Reference may be made by phone or online. Dates must be

referenced prior to authorizations.

Assists with complaint and appeal process regarding eligibility / claims and documents appropriately in the UM system.

Skills :

Managed care, preferably in medical management department, claims and member service background helpful. Health

care setting employment a plus.

• Ability to operate PC, Windows, Word, fax machine, photocopier, computer and multi-line telephone.
• Excellent customer service skills and phone etiquette are required.
• Ability to handle high volume of calls, prioritize work, be flexible and perform as member of a team is required.
• ICD and CPT coding skills (preferred)

Previous health plan experience is preferred.

No, certifications required. Typing and Data Entry is required. Medical Terminology (ICD - 10 & CPT coding, Place of service knowledge is required) Customer Service experience preferred.

Education :

Required- H.S. Diploma or equivalent

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law.

Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.

If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at email protected or 844-463-6178 .

Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning.

We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package.

Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.