Utilization Management Assistant

Full-time • San Diego, California, United States • $23 - $25 / hour • 1m ago

Aya Healthcare has an exciting 13 Week Utilization Management Operations Assistant Contract Opportunity in San Diego, CA!

Job Details:

JOB TITLE: UM Operations Assistant

CONTRACT DURATION: 13 Weeks

LOCATION: San Diego, CA

SHIFT: M-F, 8:00 A.M. – 5:00 P.M. PST

ONBOARDING TIME: Expect 2 weeks from offer acceptance to start date.

Job Description:

Under the general supervision of the area Supervisor, the Utiization Management Operations Assistant position supports the daily administrative functions of Utilization Management Operations Department (UM) including processing UM letters, and other clerical functions, including copying, data entry, record-keeping, pulling authorization requests, filing, etc.

· Processes, on a daily basis, all denial and cancel/redirect letters, within mandated timeframes.

· Ensures that appropriate translation attachments and parent resource materials are included in applicable packages.

· Troubleshoots missing or incomplete denial packages & identifies issues with denial letter database.

· Prepares, electronically saves, and mails daily UM approval letters.

· Responsible for running reports on a daily basis to create approval letters, deferral/pending letters and turnaround time reports.

· Prepares, electronically saves, and mails pending/deferred letters.

· Appropriately routes all inbound fax communication to departments and individuals as needed.

· Responsible for renaming and organization of inbound faxes stored in the RightFax shared folder.

· Performs research on all failed UM notification faxes and re-faxes to appropriate providers.

· Ensures successful fax transactions and files documentation.

· Faxes, e-mails, and electronically saves all facility faxes to health plans.

· Provides backup support to the non-clinical team(s) with data entry/processing of authorization requests, including verification of benefits, research of authorization history, provider notes, and use of correct CPT/ICD10 codes.

· Assists with organizing and preparing for health plan regulatory audits of UM processes. Includes review and preparation of audit materials in conjunction with the Director, UM Operations & Manager, UM Operations.

· Assist members with administrative duties and special project(s) as assigned.

· Provides phone communication with prompt, courteous and professional phone manners at all times.

· Acts as backup for other administrative staff within the office when necessary.

Job Requirements:

· H.S. Diploma, GED, or Equivalent required; Associate’s Degree preferred

· 2 Years of Utilization Management Experience

· 2 Years of Data/Administrative Experience within a Healthcare Setting

· Working Knowledge of Medical Terminology

· Proficient knowledge of Microsoft Office products including Word, Excel, Outlook PowerPoint and Access

Application Requirements (due at time of phone screen with recruiter):

· Resume with last seven years of work history if applicable - all work history gaps of 90+ days must be explained.

· Copy of diploma for highest level of completed education.

· Two manager/supervisor references who you have worked with in the last two years.

· Upcoming requested time off for the duration of the contract.

· Interview availability for the next 7-10 days.

· Documentation of Covid vaccination or medical/religious exemption.

AYA DELIVERS…

· Front-of-the-line access to exclusive jobs at thousands of healthcare facilities nationwide.

· A robust team and dedicated recruiter to support you every step of the way to ensure you start on time, have accurate payroll and an exceptional experience.

· A credentialing specialist to streamline the entire compliance process.

· Premium medical, dental, vision and life insurance beginning day one of your assignment.

Aya Healthcare is an Equal Opportunity Employer and encourages all to apply!

Job Types: Full-time, Contract

Pay: $23.00 - $25.00 per hour

Expected hours: 40 per week

Benefits: