Medical Management Resolution Specialist (Per Diem)
UHS
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.
Job description
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 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.
- Ability to effectively communicate in English, both verbally and in writing.
- 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.
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
- Ability to effectively communicate in English, both verbally and in writing
- 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
Benefits
- Loan Forgiveness Program
- Competitive Compensation
- Paid Time Off
- Medical, Dental & Vision
- Prescription Drug Plans
- 401(k) Matching
- Discounted Stock Plan
- Student Loan Refinancing
- Career Development
Company overview
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected providers of hospital and healthcare services, operating as a Fortune 300 corporation headquartered in King of Prussia, Pennsylvania. Founded in 1979, UHS has grown into a major healthcare enterprise with approximately 99,000 employees and annual revenues exceeding $14 billion. The company operates through its subsidiaries, managing 29 acute care hospitals, 331 behavioral health facilities, and 60 outpatient and other facilities across 39 U.S. states, Washington D.C., Puerto Rico, and the United Kingdom. UHS provides comprehensive healthcare services including acute care, behavioral health treatment, cancer centers, and ambulatory surgical centers. The company's strategy focuses on building or acquiring high-quality hospitals in rapidly growing markets and investing in advanced medical equipment and skilled personnel to become the leading healthcare provider in each community it serves. UHS is publicly traded on the New York Stock Exchange (NYSE: UHS) and has established a strong reputation for delivering compassionate, high-quality care while maintaining financial stability and operational excellence.