Anthem Utilization Management Representative I - Albany, NY - PS13562 in Albany, New York

Utilization Management Representative I - Albany, NY - PS13562


Location: Albany, New York, United States

Field: Customer Service

Requisition #: PS13562

Post Date: 4 days ago

Your Talent. Our Vision. At Empire Blue Cross Blue Shield, a proud member of the Anthem, Inc. family of companies, 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.

Utilization Management Representative I Responsible for coordinating cases for precertification and prior authorization review.

Primary duties may include, but are not limited to:

• Managing incoming calls.

• Determines contract and benefit eligibility; build authorization requests, outpatient precertification, and prior authorization.

• Refers cases requiring clinical review to a Nurse reviewer.

• Responds to telephone and faxed inquiries from clients, providers and in-house departments.

• 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

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.

• This position will be located in Albany, NY and hours are 8:30-5:00PM EST.

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

• Current working knowledge of ACMS, CS90, CCB, NASCO, and ICD10 preferred.

• Current working knowledge of the UM Intake processes and procedures preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.