Utilization Management Representative

Job Summary

A company is looking for a Utilization Management Representative.

Key Responsibilities

• Perform data entry of prior authorization requests accurately to meet turnaround time standards
• Contact Health Plans for medical policies or benefit interpretations
• Manage the referrals process, including processing incoming and outgoing referrals and prior authorizations

Required Qualifications

• High School Diploma/GED (or higher)
• 1+ years of experience in a healthcare environment, physician's office, or insurance company
• 1+ years of experience with medical terminology, ICD, and CPT coding
• Intermediate proficiency with computers and Windows-based programs, including Microsoft Word and Outlook
• Ability to work flexible 10-hour shift schedules during normal business hours