- High school graduate or equivalent
- Prior experience in medical office, social service or case management
experience a plus.
- Superior customer service and phone skills; strong verbal communication, writing, problem solving, time management, and organizational skills
- Must possess professional writing skills and ability to correspond with professionals both verbally and in writing
- Ability to accurately type 35 words per minute
- Must have strong spreadsheet and database skills to include intermediate proficiency with Microsoft Excel, Word and Outlook)
Environmental and Working Conditions:
- Entire work time is conducted in an office setting
Physical and Mental Requirements:
- Must be able to understand and follow complex instructions
LogistiCare is the nation's leading managed healthcare organization specializing in the management of healthcare transportation benefits. LogistiCare’s client base consists of state and local government agencies (Medicaid agencies, transit authorities, school boards), managed care organizations and hospitals. LogistiCare is not a provider of transportation vehicles (we do not physically own vehicles). Instead, LogistiCare manages a network of transportation providers and provides the administrative infrastructure to authorize services and provide billing and claims payment functionality allowing LogistiCare to offer a complete outsourcing solution to our clients.
We seek a Utilization Review Specialist to join our growing company.
Essential Duties and Responsibilities:
- Determines member eligibility
- Verifies the appropriateness of service levels
- Manages the denial and appeal process
- Monitors exceptional distance report
- Confirms utilization of the closest medical provider of services
- Assists with standing order recertification
- Audits whether provider billed for previously cancelled trips and/or was paid for trips that did not occur
- Performs other duties as assigned
Note: This description is not intended to be all-inclusive. Employee may be requested to perform other duties from time to time.
LogistiCare is an Equal Opportunity Employer.
Logisticare - 30+ days ago