Medical Assistant - Utilization Specialist (Remote)

United States Job Openings

Spectrum Healthcare Resources

Seattle

October 26, 2024

Job Description:

Spectrum Healthcare Resources has a potential need for a Medical Assistant - Utilization Specialist. The position provides Case Management services for TRICARE beneficiaries. The Utilization Specialist is responsible for the administration of utilization management to include clerical, administrative, operational and customer support assignments. Ensures accurate data entry into medical management system by key-entering authorizations and referrals requests. Triaging inbound calls, conducting outbound calls and managing faxed documentation. Supports Clinical Operations by prioritizing task and work assignments. Reports to the Supervisor, Utilization Management.

Requirements

High School Diploma or G.E.D.
U.S. Citizen
Must be able to receive a favorable Interim and adjudicated final Department of Defense (Do D)
background investigation
3+ years experience in administrative or medical office
Proficient knowledge of medical terminology
Proficient computer skills including Micorosft Office Suite (Teams, Word, Excel and Outlook)
Proficient data entry skills

Preferred

Experience in a customer service healthcare environment
Medical Assistant diploma or certificate of completion or equivalent
Managed Care experience

Responsibilties:

Processes authorization requests in the medical management system.
Works with standard coding systems including: Standard Medical Taxonomy, International Classification
for Diseases, Current procedural Terminology and Health Care Financing Administration Common
Procedure Coding System.
Provides outreach for and receipt of medical records in support of UM processes and workflows.
Reviews and completes documentation of non-clinical criteria for UM processes and workflows.
Communicates with other departments, medical providers, and beneficiaries to clarify documentation prior
to processing
Consistently displays professional and courteous service skills to internal and external customers.
Utilizes various computer software applications
Generates and sends out written correspondence.
Audits peers authorizations for accuracy and completeness.
Performs other duties as assigned.
Understands procedures and processes of the TRICARE Program
Takes appropriate measures to comply with HIPAA regulations to protect privacy of beneficiaries personable
identifiable information (PII) or protected health information PHI

Company Overview:
Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of Team Health, a Nationwide organization that serves 850 civilian and military hospitals with a team of 9,600 affiliated health care professionals.

Spectrum Healthcare Resources is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

EOE/AA/Disability/Vet
Location : Location: US-WA-Seattle Recruiter : Full Name: First Last: Alison Johnson Direct phone number: 314-744-4199 Recruiter : Email: Alison_Johnson@spectrumhealth.com

We regret to inform you that this job opportunity is no longer available as it has expired

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