Um Specialist

S&H Youth And Adult Services in Salisbury, NC is looking for one um specialist to join our strong team. Our ideal candidate is attentive, punctual, and reliable.

The Utilization Management Specialist is responsible for accurately entering and submitting treatment authorization requests and ensuring that all consumers maintain authorizations. The Utilization Management Specialist is responsible for ensuring that all consumers in the consumer database is billing ready and monthly documentation has been submitted i.e. NC TOPPS, Target Pops, PCPs, authorizations, etc renewal dates are updated for timely submission. He/she will not directly supervise any staff or consumers but will be responsible for providing the communication to supervise/assist as directed under the management of the Program Director i.e. sending out company mail to keep staff informed. He/she will also be responsible for opening and locking up the office each day and maintaining the daily operations onsite as instructed by the Program Director.        

Responsibilities

1.      Track authorizations of consumers. Run reports of all authorized and non-authorized clients. Request authorization for all unauthorized clients. Email staff to remind them of TAR(treatment authorization request) submission due dates.

2.      Review all submitted treatment authorization requests for acuity and completeness. Return all TARs that are incomplete. Enter and submit treatment authorization requests that have been completed accurately to ensure that all consumers maintain authorizations.  

3.      Work in a cooperative effort with involved professionals to ensure that program plans are completed, signed by physician/practitioner, and logged so that they may be implemented and services may be authorized, updated, and billed for properly in a timely fashion.

4.      Upon receipt of authorization, enter authorization into EHR system. Email all authorizations to appropriate staff. Ensure all clinical data/requests are submitted to the appropriate individuals in a professional and timely manner to ensure all treatment recommendations have been completed by the next auth period.

5.      Attend and actively participate in meetings and training as required. Take minutes for all staff meetings orchestrated by the program director in absence of an admin assistant. Complete any other assigned duty as requested by the supervisor.

Qualifications

• Have a high school diploma, bachelor degree preferred
• Be able to manage projects; conduct research; and disseminate information by using the telephone, mail services, Web sites, and email.
• Operate a variety of office equipment, including fax machines, photocopiers, scanners, videoconferencing, and multi-line telephone systems.
• Create spreadsheets, compose correspondence, manage databases, and develop presentations, write reports, using desktop publishing Microsoft office software and digital graphics.
• Have at least two years of experience or certification and working knowledge and skill in the application of philosophies, practices, principles, and techniques in designing and implementing medical billing, providing direct care services, and tracking services.

We are looking forward to hearing from you.