CoreCare Utilization Management Specialist

Join the VitalCore Team in Kansas! We're people fueled by passion, not by profit!VitalCore Health Strategies (VCHS), an industry leader in Correctional Healthcare, has an opening for a CoreCare Utilization Management Specialist at our Corporate Office in Topeka, Kansas! (Must be a certified Medical Coder with at least 10 years of experience).Looking for a rewarding career with competitive wages, annual incentive bonus, and excellent benefits package?At VitalCore we pride ourselves on retaining and acquiring compassionate, dedicated individuals who are committed to providing quality services. Join our team and experience first-hand how VitalCore Health Strategies promotes a positive work environment that is based on respect and appreciation of the hard work and dedication of our staff.CORECARE UTILIZATION MANAGEMENT SPECIALIST BENEFITS PACKAGE:Holiday Pay: New Year's Day, Martin Luther King Jr. Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Veteran's Day, Thanksgiving Day, and Christmas DayMedicalDentalVisionHealth Savings AccountLife InsuranceShort Term/Long Term DisabilityIdentity Theft ProtectionPet InsuranceEmployee Assistance Program and Discount Center401K & Plan MatchingPTODependent Care Flexible Spending AccountAnnual Incentive BonusCORECARE UTILIZATION MANAGEMENT SPECIALIST POSITION SUMMARYThe CoreCare Utilization Management (UM) Specialist is responsible for the review of all applicable data to confirm the correct application of clinical and benefits administration procedural guidelines for all data related to patient claims processing. The CoreCare UM Specialist provides accurate, prompt, and appropriate medical authorization information to requests from Clinicians, Vendors, and Providers.CORECARE UTILIZATION MANAGEMENT SPECIALIST ESSENTIAL FUNCTIONSResponsible for accurate flow of medical information between patients, outside providers and third-party payer.Researches and analyzes data for accuracy required for reimbursement.Analyzes medical billing and identifies documentation deficiencies.Uses established criteria to conduct preliminary decision review for services requiring prior authorizationAssesses the need for additional information to complete a service decision requestWorks closely with UM RN staff to escalate decisions that require clinical review and oversightCommunicates results of reviews in CoreCare Utilization Management program for the primary care team and clinical reviewersHandles all requests for review of authorization and data accuracy timely and accuratelyFollows department and organizational policies and procedures as well as adheres to all applicable regulatory, contractual, and compliance requirementsCORECARE UTILIZATION MANAGEMENT SPECIALIST REQUIRED EDUCATION, CERTIFICATIONS,AND EXPERIENCE:Associate's Degree or equivalent experience - Bachelor's DegreeCertification in Medical Coding10+ years professional work experience in health care, managed care, or insuranceEducation, training or experience as a medical coder, medical billing, Insurance Coordinator requiredEnglish required, bilingual preferredProficient in Microsoft Suite, specifically ExcelCORECARE UTILIZATION MANAGEMENT SPECIALIST MINIMUM REQUIREMENTSGreat customer service skills, including interpersonal conversation, patience and empathyGreat problem-solving and critical thinking skillsFamiliarity with utilization management reviewKnowledge of CPT and ICD coding highly preferredFlexibility and understanding of individualized care plansExcellent interpersonal, verbal, and written communication skillsAbility to work independently and make decisionsWork in a team based environmentExcellent attention to detailWorking knowledge of and ability to navigate through the healthcare system (insurances, Medicare, Medicaid, physician office operations)Experience with Crystal Reports preferredAbility to maintain the security of patient information/ adhere to HIPAA requirementCORECARE UTILIZATION MANAGEMENT SPECIALIST SCHEDULEFull-timeMon-Fri8AM - 5PMVitalCore Health Strategies is an equal opportunity employer and committed to creating and maintaining an inclusive workplace in which all employees have an opportunity to participate and contribute to the success of the business and are valued for their skills, experience, and unique perspectives.Keywords: Director of IT, information technology, IT Manager, Information Technology manager, #indmg #ZRMon-FriFull-time8AM - 5PM

Created: 2024-11-04