Utilization Review Assistant (Workers Compensation)
Omaha, Nebraska
Claims Medical Management – Utilization Review /
Non-Exempt /
Hybrid
WHAT WE'RE LOOKING FOR
The Utilization Review Assistant ensures the timely and accurate collection of data and documents necessary for the utilization review process as well as independent medical review.
ONSITE REQUIREMENT (NON-NEGOTIABLE)
This is a hybrid opportunity, requiring initial onsite training and, upon successful completion of same, a minimum requirement of three days per work week in our Omaha, NE office; Wednesday being a required all-hands Collaboration Day.
ESSENTIAL RESPONSIBILITIES
- Triage and manage intake coordination of requests for authorization and independent medical review requests.
- Examine requests for legibility and take appropriate action to ensure accuracy of data entry and documentation.
- Correctly identify medical documents and index to claim files as instructed.
- Efficiently organize, prepare, image and download medical reports and claim letters while maintaining data integrity.
- Accurately enter data timely to track independent medical requests and final determinations.
- Proactively communicate any problems or issues that may adversely impact a client or the company timely to manager.
- Ensure work is performed in accordance to Company standards, training, and supervisory direction to ensure compliance with corporate and regulatory standards.
- Provide general office or administrative support throughout department.
- Foster a positive and close working relationship with other Company staff, including Medical Management, Special Investigations, Legal, Nurse Case Management, Customer Care, Client Services, Marketing, and Underwriting.
REQUIRED QUALIFICATIONS
- EDUCATION/EXPERIENCE: High School diploma required. Associate’s degree from an accredited college or technical school highly preferred.
- EXPERIENCE: Minimum of six months of relevant experience highly preferred. An equivalent combination of education and experience will be considered.
- LANGUAGE ABILITY: Able to read and interpret documents such as safety rules, operating and maintenance instructions, procedural manuals, claim notes, and claim data fields. Able to write routine reports and correspondence.
- MATH ABILITY: Able to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Able to compute rate, ratio, and percent.
- REASONING ABILITY: Able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Able to deal with problems involving several concrete variables in standardized situations.
- COMPUTER SKILLS: Proficient in Microsoft Office Suite applications ( Word, Excel, PowerPoint). Able to quickly master proprietary and vended software applications.
