Job description
Athens Position Details
Position Title: Utilization Review Specialist
Department: Managed Care – Orange, CA
Reports To: Utilization Review Clinical Supervisor
FLSA Status: Non-Exempt
Job Grade: 6
ATHENS ADMINISTRATORS
Since our founding in 1976, Athens Administrators has been a recognized leader in third-party claims administration services. However, more important than what we do is how we do it. Athens employees provide service that translates into real and lasting benefits—every single day! With offices throughout the United States, Athens Administrators offers Workers’ Compensation, Property & Casualty, Managed Care and Program Business solutions. Athens is proud to be a third-generation family-owned company and is dedicated to its core values of honesty and integrity, a commitment to service and results, and a caring family culture. We are so proud that our employees have consistently voted Athens as a Best Place to Work!
POSITION SUMMARY
Athens Administrators has an immediate need for a full-time Utilization Review Specialist to support our Athens Managed Care department and can be located remotely if technical requirements are met and the employee resides in a state Athens operates in (California, Oregon, Oklahoma, or Texas).
The schedule for this position is Monday-Friday from 9am – 5pm PST with a 30-minute meal break, 37.5 hours a week. The Utilization Review Specialist assists the utilization review process taking on various tasks including data collection of demographic, claim and medical information; non-medical analysis; and outcomes reporting.
PRIMARY RESPONSIBILITIES
Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:
- Abundant data entry
- Enters initial data and starts workflow processes
- Initiates and modifies demographic information, physician and facility information, performs quality check of data feed information
- Validates that the request for authorization is complete or requests additional data from requesting physician if necessary
- Run request for authorizations through rules engine for direct approval
- Assign cases to next level reviewer if they do not meet criteria for direct approval
- Answers general phone calls and/or emails in a professional manner and directs to the appropriate party as required
- Complete other projects and tasks as assigned by management
- Follow all regulatory policies and procedures, privacy and security standards in accordance with government agencies including HIPAA requirements.
- Other duties as assigned
ESSENTIAL POSITION REQUIREMENTS
The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
- High School Diploma or equivalent (GED) required for all positions
- AA/AS or BA/BS preferred but not required
- Minimum of one year data entry experience, preferably in medical or insurance industry
- One year work experience in corporate environment preferred
- Knowledge of, or ability to learn, and apply basic medical terminology and ICD-9/10
- One year customer service experience minimum
- Time management skills and the ability to work independently in order to meet goals and sensitive timelines
- Well-developed verbal and written communication skills with strong attention to detail
- Excellent organizational skills and ability to multi-task
- Ability to type quickly, accurately and for prolonged periods
- Proficient in Microsoft Office Suite
- Ability to learn additional computer programs
- 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
- Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
APPLY WITH US
We look forward to learning about YOU! To be considered, please submit your resume and application directly through our website at http://www.athensadmin.com/careers/job-openings/ Feel free to include a cover letter if you’d like to share any other details. All applications received are reviewed by our in-house Corporate Recruiter.
This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.
Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.
THANK YOU!
We look forward to reviewing your information. Applying for jobs isn’t necessarily fun, but we promise we are. Don’t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages!
Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Additionally, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. Further information about our comprehensive benefits package may be found on our website at
https://www.athensadmin.com/careers/why-work-here
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