Utilizaton Management Specialist
Job description
Coordinate and manage incoming/outgoing correspondence such as referrals, prior authorizations, provider reconsiderations and other requests for service. Verify provider contracting status and member eligibility to any applicable pre-existing period.
We’re looking for Utilization Management Rep with:
- 2 years’ relevant experience
What a day of a Utilization Management Rep would look like:
- Review’s member eligibility and benefit structure for requested referrals or prior authorizations.
- Responds to incoming calls from internal and external customers via multiple types of media.
- Review documentation and requests additional information needed to complete review of requested services.
- Initializes, routes, and complete, as appropriate, request for services. Informs members and providers of determination.
- Enters and maintains documentation per policy and procedures.
- Completes correspondence according to established workflows.
- Performs other duties and responsibilities as assigned.
Additional skills that we are looking for:
- Good verbal and written communication skills
- Medical terminology
- Familiar with ICD10 and CPT coding
- Problem Solving
Additional details:
Duration of role is between 6 months to 1 year
Onsite work location in Meridia, ID
Dexian is a leading provider of staffing, IT, and workforce solutions with over 12,000 employees and 70 locations worldwide. As one of the largest IT staffing companies and the 2nd largest minority-owned staffing company in the U.S., Dexian was formed in 2023 through the merger of DISYS and Signature Consultants. Combining the best elements of its core companies, Dexian’s platform connects talent, technology, and organizations to produce game-changing results that help everyone achieve their ambitions and goals.
Dexian’s brands include Dexian DISYS, Dexian Signature Consultants, Dexian Government Solutions, Dexian Talent Development and Dexian IT Solutions. Visit https://dexian.com/ to learn more.
Dexian is an Equal Opportunity Employer that recruits and hires qualified candidates without regard to race, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.
