Healthcare Utilization Management Intake Analyst Associate I – BPM
Who we are:
Advantasure is a growing company and a member of the UST HealthProof family, Advantasure champions innovative solutions with an eye on the future—providing health plans with the flexibility to adapt to a changing regulatory environment and evolving business needs. Leveraging the industry’s leading experts in government-sponsored health plans, Advantasure offers solutions for administrative cost management, quality patient outcomes and experiences, enrollment growth, risk adjustment and quality and provider engagement initiatives.
We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States.
UST HealthProof is searching for a Healthcare Utilization Management Intake Analyst who will support coordination of medical services including utilization management intake, requesting medical records, and provider requests to promote effective utilization of healthcare services. Promotes and supports utilization management team as required.
The Opportunity :
- Provide support services to team members by answering incoming telephone calls, taking messages, researching information, and building authorizations in the UM system.
- Requesting medical records for pending authorizations or continued stay authorizations.
- Generate UM letters for members and providers when authorizations are not required.
- Refers to needed services by benefit plan.
- Maintain accurate and complete documentation of required information that meets quality standards.
- Protect the confidentiality of the member information and adhere to the company policies regarding confidentiality.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
What you need:
- High school diploma or G.E.D. required. Associate or bachelor’s degree in healthcare-related field is preferred. Current unrestricted LPN license or certified Medical Assistant designation preferred.
- Minimum of one year experience in a healthcare-related field.
- The preferred setting is a hospital, medical doctor’s office, or health insurance company.
- Experience with medical terminology and concepts used in the healthcare delivery system, provider office, or the insurance industry is required.
- Computer literacy to include Microsoft Office products,
- Advanced technical skills in the use of hardware and software with a high degree of accuracy.
- Excellent oral and written communication skills for representation of clear and concise results.
- Ability to manage significant workload, and to work efficiently under pressure, meeting established deadlines with minimal supervision.
- Strong time management skills.
- Must possess a high degree of accuracy, efficiency, and dependability.
- Strong customer service skills to assist members and/or providers with understanding healthcare information and coordinate issue resolution.
- Effective written and verbal communication and feedback.
- Effective organizational skills with the ability to be flexible and prioritize tasks.
- Knowledge of educational assessments and learning strategies.
- Must be knowledgeable of and able to use standard, basic grammar, punctuation, and spelling.
Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits.
What we believe :
We’re proud to embrace the same values that have shaped UST and its subsidiaries since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it’s those same values that are inspiring us to encourage innovation from everyone to champion diversity and inclusion and place people at the center of everything we do.
- Humility: We will listen, learn, be empathetic and help selflessly in our interactions with everyone.
- Humanity: Through business, we will better the lives of those less fortunate than ourselves.
- Integrity: We honor our commitments and act with responsibility in all our relationships.
Equal Employment Opportunity Statement
UST is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
UST reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.