AmeriHealth Caritas Utilization Management Technician in Baton Rouge, Louisiana
Utilization Management Technician
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At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .
Under the general supervision of the Supervisor, Utilization Management, this position screens calls from members and providers providing information to members regarding the accessing of care and assisting providers in the authorization process.
- 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.
- High School Diploma or equivalent required.
- Minimum 2 years call center environment experience within a managed care organization (preferred) or health care organization.
- Demonstrated experience managing multiple call lines and successfully triaging calls.
- Minimum 2 years’ experience in a customer service oriented role within an office environment.
- Knowledge of medical terminology, ICD-10; CPT and coding experience.
- Proficiency working within a Windows based environment; familiarity using MS Office (Word, Excel, Outlook), Internet applications, and electronic medical record and documentation programs.
EOE Minorities/Females/Protected Veterans/Disabled