Temporary Utilization Review Assistant
Temporary Utilization Review Assistant
Portland medical firm is looking for a temporary Utilization Review Assistant to join their busy team for up to 6 months.
Provide non-clinical support to the Utilization Management (UM) Team, including customer service, data entry, eligibility verification, and processing authorization requests. Ensure compliance with CMS, Tricare, and NCQA standards.
Key Responsibilities:
- Respond to authorization requests and inquiries from members/providers via phone (8 AM–4:30 PM).
- Screen, review, and process authorization requests per guidelines; upload documents to the system.
- Generate required notifications and manage notification queues.
- Distribute daily census information to facilities as needed.
- Support departmental meetings and improvement initiatives.
- Adhere to compliance standards and assist other non-clinical areas as required.
Qualifications:
- Education/Experience: Associate’s Degree or equivalent; 2+ years in managed care/call center. Knowledge of CPT, ICD-10, and HCPCS coding is a plus.
- Licenses/Certifications: Medical Assistant Certification (preferred).
Skills & Competencies:
- Knowledge of medical terminology, healthcare benefits, and managed care plans.
- Proficiency in Microsoft Word, Excel, and healthcare databases.
- Familiarity with CMS/NCQA regulations (preferred).
- Strong organizational, multitasking, and communication skills.
- Ability to handle confidential information and work independently.
- Problem-solving and critical-thinking abilities; collaborative mindset.
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