Utilization Management Support Specialist
Location: Milwaukee, Wisconsin, United States
Remote Opportunity: 0
Requisition Number: 2934
Position Title: Utilization Management Support Specialist
The Utilization Management Support Specialist provides various critical components necessary to day-to-day operational functions while ensuring proper workflow between the Utilization Management Department, providers and internal departments. The Utilization Management Support Specialist coordinates Continuation of Care orthodontic benefits.
PRIMARY JOB RESPONSIBILITIES:
- Determine dollar amount, calculate financial responsibility, and enter Orthodontic Continuation of Care cases based on prior claims submitted, submitted explanation of benefits, treatment plan and other supporting documentation.
- Review, research and respond to inquiries routed via telephone, follow-ups, and email.
- Investigate and manage orthodontic reimbursement inquiries with Client/Provider Engagement, Claims, and Customer Service departments.
- Verbally communicate authorization decisions to providers, request additional information when necessary, and appropriately document the phone call in DentaQuest’s system.
- Coordinate, manage and distribute incoming faxes to facilitate distribution to appropriate parties within the organization.
- Assemble Ortho CAD (electronic orthodontic requests) submission forms in preparation for review.
- Prepare and Coordinate general anesthesia/IV requests Organize, coordinate and communicate Outpatient Facility Requests to appropriate State and/or Managed Care Organizations.
- Process requests received in the Outpatient Facility Specialist queue.
- Communicate to management ways to improve processes and productivity of company.
- Adhere to DentaQuest business processes.
- Assist with administrative and other duties as assigned.
- High School Diploma or equivalent.
- 1 year experience in clerical setting
- Knowledge of general computer software.
- Knowledge of telephone systems.
- Knowledge of dental terminology.
- Typing skills of 30+ wpm.
- Ability to read Explanation of Benefits.
- Good interpersonal skills.
- Ability to work independently.
- Good PC Skills.
- Excellent verbal communication skills.
- Excellent mathematical skills.
- Excellent analytical skills.
- Good judgment and ability to resolve payment issues.
- Ability to prioritize and organize multiple tasks.
- Ability to remain organized with multiple interruptions.
- Required to attend additional training as requested/deemed necessary.
PHYSICAL DEMANDS: Incumbent must be able to communicate effectively. Requires overall light physical effort (up to 25lbs.) Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal computer). Ability to travel or move about within and outside serviced facilities required. Incumbent works primarily in either a private or shared office environment
Community / Marketing Title: Utilization Management Support Specialist
At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.
Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it.
To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.
The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.
Location_formattedLocationLong: Milwaukee, Wisconsin US
CountryEEOText_Description: Equal Employment Opportunity Statement: DentaQuest is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, sex, age, disability, marital status, or sexual orientation.