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Utilization Management Rep II

Location:
Job Family: Customer Service
Req #: PS48444
Date Posted: May 13, 2021

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. 

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.

Responsible for managing incoming calls, including triage, opening of cases and authorizing sessions. Primary duties may include, but are not limited to:

•    Managing incoming calls or incoming post services claims work.
•    Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
•    Obtains intake (demographic) information from caller.
•    Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given.
•    Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. 
•    Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization. 
•    Verifies benefits and/or eligibility information. 
•    May act as liaison between Medical Management and internal departments. 
•    Responds to telephone and written inquiries from clients, providers and in-house departments. 
•    Conducts clinical screening process. 
 

Qualifications

Must be available to work a flexible schedule between the hours of 4:00PM – 7:00AM CST to include weekends and holidays (day or night)

 

•    Requires a High School diploma/GED.
•    2 years of customer service or call center experience in a healthcare related setting and medical terminology training; or any combination of education and experience, which would provide an equivalent background.
•    Medical terminology training and experience in medical or insurance field preferred.
•    Experience with diagnosis codes and current procedural terminology (CPT) codes, an added plus.
•    Experience working overnights would be an added plus.
•    Proficient with Microsoft Office Suite/MS Teams.
•    For URAC accredited areas the following applies:  Requires strong oral, written and interpersonal communication skills, problem-solving, facilitation skills, and analytical skills.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

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