Utilization Management Rep

About the position

The Utilization Management Representative at Blue Cross of Idaho is responsible for coordinating and managing correspondence related to referrals, prior authorizations, and other service requests. This role involves verifying provider contracting status and member eligibility, as well as communicating with providers to gather necessary information for service requests. The position requires strong communication skills and a solid understanding of medical terminology and coding.

Responsibilities
? Coordinate and manage incoming and outgoing correspondence including referrals and prior authorizations.
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? Verify provider contracting status and member eligibility, including pre-existing periods.
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? Communicate and coordinate with providers to obtain and verify information related to service requests.
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? Review member eligibility and benefit structure for requested referrals or prior authorizations.
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? Respond to incoming calls from internal and external customers via various media.
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? Review documentation and request additional information needed for service review.
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? Initialize, route, and complete requests for services as appropriate.
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? Inform members and providers of determinations regarding requests.
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? Enter and maintain documentation according to policy and procedures.
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? Complete correspondence according to established workflows.
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? Perform other duties and responsibilities as assigned.

Requirements
? 2 years of relevant experience in utilization management or a related field.
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? Strong communication skills, both verbal and written.
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? Knowledge of medical terminology.
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? Familiarity with ICD-10 and CPT coding.

Nice-to-haves
? Problem-solving skills.

Benefits

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