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Kelly Services, Inc.


United States

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Utilization Management Representative


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Job ID:

16842

Location:

Indianapolis, IN, United States 

Category:

Insurance

Salary:

$16.00 per hour
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Job Views:

92

Zip Code:

46201

Employment Type:

Contract - W2

Posted:

09.22.2016
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Key Skills:

call center AND insurance

Job Description:

SUMMARY
·         Responsible for coordinating cases for precertification and prior authorization review.

MAJOR JOB DUTIES AND RESPONSIBILITIES: Primary duties may includes, but are not limited:
·         Managing incoming calls or incoming post services claims work.
·         Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
·         Refers cases requiring clinical review to a Nurse reviewer.
·         Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
·         Responds to telephone and written inquiries from clients, providers and in-house departments.
·         Conducts clinical screening process.
·         Authorizes initial set of sessions to provider.
·         Checks benefits for facility based treatment.
·         Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

EDUCATION/EXPERIENCE
·         Requires High school diploma
·         1 year of customer service or call-center experience; proficient analytical, written and oral communication skills; or any combination of education and experience, which would provide an equivalent background.
·         Medical terminology training and experience in medical or insurance field preferred.



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