carrierlist.co - Today's career recruitment can be quite competing, that's why you need to do the job properly in fact it is not really a hard course of action. carrierlist.co will give you chance to undertake it so that you could help to make the right selection with much better strategy to acquire rapid as well as greater effect. This way you'll get better probability and also more secure reside down the road. Anthem, Inc. is one of the corporations you can confidence to give family and friends ideal along with better live sometime soon. Subscribing to the corporation can make an individual capable of accomplish the goal less difficult along with help to make the desire come true.

To create the business imaginative and prescient vision as well as quest happens accurate; Anthem, Inc. will be available with regard to new position while Position as Utilization Management Representative I/II -WAH Companies Anthem, Inc. in Indianapolis, IN in January 2018 within Indianapolis, IN originate from January 2018. Everyone who's thinking about answering this specific empty, you should take part in this kind of Position as Utilization Management Representative I/II -WAH Companies Anthem, Inc. in Indianapolis, IN in January 2018 January 2018 recruitment throughout Indianapolis, IN. It truly is advised for many members to arrange all needed needs with this career recruitment process, because practice requires that you allow suitable specification that the company desires just for this situation. If you think you are the one that could fill up the options, you can attempt to learn more information about Position as Utilization Management Representative I/II -WAH Companies Anthem, Inc. in Indianapolis, IN in January 2018 January 2018 in Indianapolis, IN below.

.

Utilization Management Representative I/II -WAH

Company Anthem, Inc.
Location Indianapolis, IN
Update 8 Day ago
300
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 benefits companies and a Fortune Top 50 Company.

Utilization Management Rep I-III

* Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.*

Description

Level I:

Responsible for coordinating cases for precertification and prior authorization review.

Primary duties may includes, but are not limited:

* 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.

* Refers cases requiring clinical review to a Nurse reviewer.

* Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.

* Responds to telephone and written inquiries from clients, providers and in-house departments.

* Conducts clinical screening process.

* Authorizes initial set of sessions to provider.

* Checks benefits for facility based treatment.

* Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Level II:

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

Qualifications

Level I:

* Requires High school diploma/GED;

* 1 year of customer service or call-center experience; proficient analytical, written and oral communication skills;

* or any combination of education and experience, which would provide an equivalent background.

* Medical terminology training and experience in medical or insurance field preferred.

Level II:

* Requires HS diploma or equivalent;

* 2 years customer service experience in healthcare related setting and medical terminology training;

* or any combination of education and experience, which would provide an equivalent background.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.