• Job Description

  Req#: UTILI002771
  Employer Industry: Healthcare Services
  
  Why consider this job opportunity:
  - Salary up to $22.50 per hour
  - 5% annual incentive target based on performance goals
  - Comprehensive benefits including medical, dental, vision, and 401(k) with employer match
  - Generous time off policies including 17 days of PTO and 10 standard holidays
  - Opportunity to work in a supportive environment focused on community health
  - Chance to contribute to the wellbeing of members and improve healthcare access
  
  What to Expect (Job Responsibilities):
  - Process data entry for referrals, prior authorizations, and hospital notifications
  - Determine appropriate medical coding using CMS, NCQA, and HCA criteria
  - Validate benefit and prior authorization requirements within the Care Management system
  - Review and approve authorization requests, referring complex cases to clinical staff
  - Ensure accuracy and compliance of denial letters and maintain timely communication
  
  What is Required (Qualifications):
  - Associate degree or equivalent combination of education and relevant experience
  - Minimum of one (1) year of customer service experience
  - Experience in a healthcare or managed care setting
  - Knowledge of medical terminology and healthcare processes
  - Ability to work independently and maintain confidentiality
  
  How to Stand Out (Preferred Qualifications):
  - Familiarity with Washington Apple Health and Medicare Advantage Plans
  - Strong analytical skills with the ability to interpret and evaluate data
  - Proficiency in Microsoft Office products
  - Experience in care management workflow systems
  - Effective verbal and written communication skills with healthcare providers
  
  #HealthcareServices #UtilizationManagement #CareerOpportunity #CompetitivePay #EmployeeBenefits
  
  "We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
  We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer."

• About the company

  Community Health Plan of Washington puts you at the center of your care, so when your needs change, we change too. That includes expanding our virtual care services, making personal phone calls to check on you, and providing home delivery of your presc...

Notice