Utilization Management Assistant (UMA) at Independent Health Association in Williamsville, New York

Job Description:

Overview

The UMA provides administrative support to the Utilization Management, departments. The UMA is the first line of review in the UM prior authorization process, reviewing for eligibility and benefit. The UMA is responsible for intake of clinical information, data entry of requests, preparation of the documents for clinical review and/or administrative review per standard operating procedures and various other tasks in support of initiatives and programs. The UMA is accountable for maintaining departmental productivity and quality metrics and completing assigned tasks in compliance with regulatory and departmental requirements.
Qualifications
- High School diploma or GED required.
- Two (2) years of medical office or health insurance experience required OR one (1) year of Independent Health temporary experience working within the same position and/or department required.
- Solid verbal, written and interpersonal communication skills required. Demonstrated customer service skills required.
- Knowledge/experience of medical billing procedures, CPT, and ICD-9 coding preferred.
- Demonstrated proficiency in data entry.
- Excellent organization skills, with attention to detail and follow-through.
- Ability to meet and/or exceed all established performance standards on a consistent basis (i.e., regulatory timeframes, accuracy, and quality).
- Demonstrated proficiency with PC navigational skills.
- Ability to work flexible hours and/or overtime as needed.
- Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
- Process all UM service requests received by phone, fax, mail, Info clique and Midas.
- Complete verification of eligibility and benefits for the requested service.
- Initiates case for review in all pertinent systems to include, but not limited to: Macess, Aerial, Siebel and Health Rules, and routes cases to the appropriate department for review.
- Complete all necessary data entry and action to complete the review process for each request. This includes accurately documenting and issuing appropriate written and verbal notification to providers and members within the regulatory timeframes.
- Ensure compliance with all regulatory and departmental requirements. Accountability for attainment of productivity and quality metrics.
- Assist the supervisor with the onboard of new staff as needed.
- Research and correction of authorization discrepancies received through Siebel and Macess.
- Review documents received by fax and file to appropriate work queue by checking various systems to obtain information to make determination. Also file emailed documents to the appropriate member's folder.
- Handle receipt and processing of all department incoming mail which includes opening, sorting, prepping and scanning documents.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via their Career Worklet.

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