Corewell Health
healthcare
UtilizationMgmtSpec
“Utilization Mgmt Spec at Corewell Health. Skills: process management, cross-functional coordination, vendor/stakeholder management, operational metrics, resource planning, continuous improvement, communication skills. Assists in the provision of the highest service level possible to patients/customers to ensure their satisfaction.. Participates in activities with third party payors in order to maximize reimbursement.”
What You'll Achieve.
maximize reimbursement; ensure patient/customer satisfaction
Industry & Context.
Problem solves issues that are received via phone, fax or email.
MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category.
What They're Looking For.
Must Have
High School Diploma or equivalent
Nice to Have
Post high school training and/or academic coursework leading toward associate’s or bachelor’s degree, 2 years of relevant experience healthcare experience
What You'll Do.
Assists in the provision of the highest service level possible to patients/customers to ensure their satisfaction.
Participates in activities with third party payors in order to maximize reimbursement.
Understands and accesses insurance websites.
Completes required duties as defined for specific payers to obtain authorization numbers for payment.
Provides clerical support for Utilization sorting faxes and mail
obtaining authorization numbers
completing follow-up on outstanding cases
and delivery of letters associated with outpatient or inpatient status.
Utilizes electronic medical record work queues that support Utilization Management functions.
Answers incoming calls or places outbound calls with appropriate communication skills.
Triages all calls to the appropriate person for resolution and action or completes appropriate follow-up.
Problem solves issues that are received via phone
How You'll Work.
Team & Collaboration
cross-functional coordination
Communication Scope
appropriate communication skills
Applying for this Utilization Mgmt Spec role?
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