DescriptionThe Healthcare Specialist contributes to administration of utilization management, performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.
There is in office training in Glenn Allen, VA, Mon-Fri 8am-5pm, the first week of training.
The Healthcare Specialist provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
- High School Diploma
- Minimum 1 year administrative or technical support experience
- Excellent verbal and written communication skills
- Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environmentand an ability to quickly learn new systems
- Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
Proficient utilizing electronic medical record and documentation programs
Proficient and/or experience with medical terminology and/or ICD-10 codes
Bachelor's Degree in Business, Finance or a related field
Prior member service or customer service telephone experience desired
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
Scheduled Weekly Hours40