Department Specialist III in Lynn, Massachusetts at Element Care

Great Life work Balance position with excellent benefits! The UM Support Specialist is a well-organized, team player who supports the SCO UM Department by creating and reviewing service authorizations for enrolled members. This is a full-time position, Monday- Friday 8-4 position; no nights, weekends or holidays!

Responsibilities:

• • Perform quality review of member service authorizations.
  • Perform outreach to internal and external partners to obtain outstanding documentation to prepare authorizations for clinical review.
  • Prioritize work based upon Service Decision timeframes (Standard vs Expedited)
  • Apply regulatory guidelines to determine member qualification for decisoning of authorizations.
  • Follow established protocols and compliance standards to ensure regulatory requirements are met.
  • Manage Centralized Electronic Record work queue for authorization assignment.
  • Serves as Subject Matter Expert concerning the UM department’s policies and procedures.
  • In supervisors’ absence, ensures that all departmental matters are handled appropriately.
  • Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
  • Required to complete annual Inter-Rater Reliability testing to decision member authorizations.
  • Provide back-up support to other areas.
  • Provide training to other non-exempt personnel.
  • Performs other duties as required.

Qualifications:

• High school diploma or equivalent.
• Previous (3-5 years) administrative or related experience required.
• Must be able to resolve issues, collaborate with a team, and understand the need for accurate and timely communication and escalation.
• Working knowledge of, or proficient in, Microsoft office applications, and quick-to-learn proprietary software packages.
• Ability to interact with all levels of internal and external personnel.
• Strong written and verbal communication skills.
• Strong organizational skills, with attention to detail.
• Strong customer service skills.
• Practice knowledge of HIPAA policies and guidelines.
• Proof of Covid vaccine

Benefits:

• Health insurance
• Dental insurance
• Vision insurance
• Paid time off
• Retirement plan

Supplemental benefits

.

EEO Statement

Element Care is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, national origin, sexual orientation, protected veteran status, or on the basis of disability.

Element Care is committed to valuing diversity and contributing to an inclusive working environment.