Utilization Management Intake Coordinator I

To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here.

Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position.

Arkansas Blue Cross is only seeking applicants for remote positions from the following states:

Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.

Job Summary

The Utilization Management Intake Coordinator I supports clinical, management, and client activities, comprising the Utilization Management (UM) program. Incumbent must be proficient in all UM processes such as pre-authorizations, claim reviews, triage and case assignments.

Requirements

EDUCATION & EXPERIENCE

Associate's degree in related field with one (1) year operations experience (health insurance industry preferred). OR minimum three (3) years' operations experience (health insurance industry preferred).

ESSENTIAL SKILLS & ABILITIES

Customer Service

Personal Computer (PC) Software

Data Entry

Time Management

Professional Etiquette

Multitasking

Logical Thinking

Oral & Written Communication

Strong Interpersonal Skills

Analyze Information

Highly Organized

Detail Oriented

Highly Motivated Self-Starter

Proficiency with MS Office Suite (Word, Excel, PowerPoint including web-based computer applications required).

Ability to work independently or as a team.

Skills

Customer Service, Data Entry, Detail-Oriented, Interpersonal, Logical Thinking, Microsoft Office (Word, Outlook, Excel, PowerPoint) (Inactive), Multitasking, Oral and Written Communication Skills (Inactive), Organized (Inactive), Professional Etiquette, Self-Starter, Time Management

Responsibilities

Conducts or supports UM system testing (as needed)., Maintains understanding of role specific regulatory requirements pertaining to UM Processes and operations., Performs other duties as assigned., Processes practitioner pre-authorization requests while adhering to administrative guidelines, policies and procedures., Processes prior authorization requests which include collecting and transferring non-clinical data and acquiring structured clinical data while adhering to administrative guidelines., Supports departmental initiatives such as policy/procedure review, audit preparation, and work instruction updates.

Certifications

Security Requirements

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties

Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

Employment Type

Regular

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.