Department Specialist III

Element Care · United States

Great Life work Balance position with excellent benefits! The UM Support Specialist is a well-organized, team player who supports the SCO UM Department by creating and reviewing service authorizations for enrolled members. This is a full-time position, Monday- Friday 8-4 position; no nights, weekends or holidays! Responsibilities:

• * Perform quality review of member service authorizations.
• Perform outreach to internal and external partners to obtain outstanding documentation to prepare authorizations for clinical review.
• Prioritize work based upon Service Decision timeframes (Standard vs Expedited)
• Apply regulatory guidelines to determine member qualification for decisoning of authorizations.
• Follow established protocols and compliance standards to ensure regulatory requirements are met.
• Manage Centralized Electronic Record work queue for authorization assignment.
• Serves as Subject Matter Expert concerning the UM department's policies and procedures.
• In supervisors' absence, ensures that all departmental matters are handled appropriately.
• Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
• Required to complete annual Inter-Rater Reliability testing to decision member authorizations.
• Provide back-up support to other areas.
• Provide training to other non-exempt personnel.
• Performs other duties as required.

• High school diploma or equivalent.
• Previous (3-5 years) administrative or related experience required.
• Must be able to resolve issues, collaborate with a team, and understand the need for accurate and timely communication and escalation.
• Working knowledge of, or proficient in, Microsoft office applications, and quick-to-learn proprietary software packages.
• Ability to interact with all levels of internal and external personnel.
• Strong written and verbal communication skills.
• Strong organizational skills, with attention to detail.
• Strong customer service skills.
• Practice knowledge of HIPAA policies and guidelines.
• Proof of Covid vaccine

• Health insurance
• Dental insurance
• Vision insurance
• Paid time off
• Retirement plan