MEDICAL MANAGEMENT RESOLUTION SPECIALIST - Hiring Fast

We are looking for a resourceful MEDICAL MANAGEMENT RESOLUTION SPECIALIST to join our exceptional team at Shift Day in Wood County, OH.
Growing your career as a Full Time MEDICAL MANAGEMENT RESOLUTION SPECIALIST is an amazing opportunity to develop useful skills.
If you are strong in decision-making, creativity and have the right personality for the job, then apply for the position of MEDICAL MANAGEMENT RESOLUTION SPECIALIST at Shift Day today!

Responsibilities

Job Summary: The Medical Management Resolution Specialist (non-clinical staff) is responsible for monitoring the daily operations with the Medical Management Department, ensuring complete and accurate information is provided on all inquiries and deadlines are met per established departmental policy and procedures, state and federal requirements, and group health plan documents.

Medical Management Resolution Specialist are responsible for the initial screening (Intake Process). For initial screening, the organization limits use of non-clinical administrative staff to: Performance of review of service request for completeness of information; collection and transfer of non-clinical data; acquisition of structured clinical data; and activities that do not require evaluation or interpretation of clinical information. The organization ensures that licensed health professionals are available to non-clinical administrative staff while performing initial screening.

Qualifications

Qualifications and Requirements:

• Associates Degree or higher or equivalent work experience preferred.
• Detailed knowledge of CPT/HCPC, ICD-9/10 coding, and medical terminology preferred.
• Previous experience in Utilization/Medical Management within a Health Plan environment is preferred.
• Must be extremely organized, detail oriented, meet deadlines, and work well under pressure.
• Language Skills: Ability to effectively communicate in English, both verbally and in writing.
• Skills: Rudimentary familiarity with Centers for Medicare & Medicaid Services (CMS) guidelines.
• Bilingual, optional/preferred but not required.
• Empathetic, Caring, Compassionate Listener.
• Able to work with a diverse multicultural and socioeconomic population.
• Familiarity with health care delivery and/or health insurance programs. 
• Ability to prioritize and multi-task.
• Strong problem-solving and critical thinking skills.
• Excellent computer skills.  Proficient in M/S Office products, including Excel, Word, Access, PowerPoint, and Outlook.
• Knowledge of medical claim processing preferred.
• Utilization management experience with a various line of business preferred.
• Excellent written and verbal communication skills.
• Must be a team player and work autonomously.
• Must be innovative, take initiative, and exercise independent judgment and decision making.
• Ability to interpret and apply health plan benefits.
• Demonstrate the ability to identify, write, and/or implements new processes for better workflow.
• Ability to interpret and adhere to established department policy and procedure as well as all state and federal requirements as it relates to the Utilization Management process.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries.  We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: or Show phone number .

Pay Transparency:

To encourage pay transparency, promote pay equity, and proactively address regulations, UHS and all our subsidiaries will comply with all applicable state or local laws or regulations which require employers to provide wage or salary range information to job applicants and employees. A posted salary range applies to the current job posting. Salary offers may be based on key factors such as education and related experience.

Benefits of working as a MEDICAL MANAGEMENT RESOLUTION SPECIALIST in Wood County, OH:

● Company offers great benefits
● Opportunities to grow
● Attractive package