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UM / Data Entry Tech

Company: Integrated Resources Inc
Location: Des Moines
Posted on: February 17, 2020

Job Description:

Job Description

Principal Accountability:

  • Screens information received and refers members to the appropriate provider and/or contacts the provider directly for members.
    • Facilitates the authorization process for requests that do not require clinical criteria application or judgment.
      • Provides relevant information to members and assists them in resolving Plan related problems when Member Services personnel are not available.
        • Acts as a resource to staff for questions related to the prior authorization process.
          • Refers unresolved prior authorization process questions to the Lead Intake Specialist.
            • Assists the Lead Intake Specialist in identifying, planning and implementing staff training programs.
              • Identifies and reports member and provider educational opportunities to the Lead Intake Specialist.
                • Accurately answers questions regarding Plan benefits and Utilization Management requirements for members and providers.
                  • Makes appropriate inquiries to determine potential coordination of benefits and advises appropriate provider and claims staff of same.
                    • Supports Utilization Management nurses with data entry.
                      • Performs other duties as assigned.
                        • Adheres to Select Health and KMHP policies and procedures.
                          • Supports and carries out the Select Health and Mercy Mission & Values.

                            Key Competencies/Success Factors:
                            • Excellent interpersonal and verbal communication skills.
                              • Attention to detail and confidentiality.
                                • Patience and a balanced demeanor.
                                  • Professional image.
                                    • Ability to write clear and concise reports.
                                      • Willingness to work any shift.
                                        • Availability for in-service training.

                                          Requirements/Certifications:

                                          REQUIREMENTS:
                                          • High School Diploma / GED
                                            • Proficient PC Skills in a Windows based environment including word processing, spread sheets and working in database programs.
                                              • Proven ability to keep accurate and timely records and documentation according to established processes
                                                • Experience as a medical assistant or role with similar responsibilities
                                                  • Experience handling multiple calls or triaging calls
                                                    • Medical Terminology, ICD, CPT, and coding experience

                                                      Additional Information

                                                      All your information will be kept confidential according to EEO guidelines.

Keywords: Integrated Resources Inc, Des Moines , UM / Data Entry Tech, Administration, Clerical , Des Moines, Iowa

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