Healthcare Utilization Specialist
hace 3 semanas
About Third Way Health:
We are a leading healthcare technology platform that helps medical practices and healthcare organizations improve patient experience while reducing administrative burden.
Our Mission:
We strive to support physicians and provide patients with a better healthcare experience, regardless of their background.
Job Description:
In this role, you will perform prior authorization verification and retrospective reviews for elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment. You will also make necessary calls to ensure all parties are aligned throughout the process.
Responsibilities:
- Conduct thorough reviews to ensure compliance and appropriate utilization.
- Make timely and accurate decisions for complex cases.
- Stay updated on state and federal regulations and accreditation standards.
- Foster effective communication with all stakeholders.
- Log cases accurately in software platforms to track and manage healthcare processes.
Requirements:
- University or associate degree preferred.
- At least 8 months of experience in health insurance.
- Strong communication skills (fluent in English and Spanish).
- Expertise in healthcare and managing call center operations.
- Great active listening skills.
- A patient and empathetic attitude.
- Strong time management and organizational skills.
- Adaptability and flexibility.
- Comfortable working in fast-paced environments.
Compensation:
The estimated salary for this position is $45,000 - $60,000 per year, depending on experience and qualifications.
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