Healthcare Utilization Specialist

hace 2 meses


Medellín, Antioquia, Colombia Third Way Health, Inc. A tiempo completo

Company Overview

Third Way Health, Inc. is a healthcare technology company that helps medical practices and healthcare organizations improve patient experience while reducing administrative burden. Our mission is to support physicians and enhance the healthcare experience for patients from all backgrounds.

About the Position

We are seeking full-time Utilization Management agents to join our team in Medellin, Colombia. As a valued member of our team, you'll play a crucial role in enhancing the healthcare experience for thousands of patients and providers in the US.

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 to ensure compliance and appropriate utilization. You will also make necessary calls as needed to ensure all parties are aligned throughout the process.

Responsibilities

  • Conduct thorough prior authorization and retrospective reviews for elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment
  • Make necessary calls as needed to ensure all parties are aligned throughout the process
  • Assess and refer cases to Medical Directors when necessary
  • Stay updated on state and federal regulations, as well as accreditation standards
  • Follow internal policies and procedures diligently to maintain operational efficiency and uphold quality standards within the team
  • Accurately log cases in software platforms to track and manage healthcare processes

Requirements

To be successful in this role, you will need:

  • University or associate degree preferred
  • Required knowledge in health insurance (at least 8 months)
  • Strong communication skills, both written and verbal
  • Expertise in healthcare, particularly in the US healthcare sector
  • A patient and empathetic attitude
  • Strong time management and organizational skills
  • Adaptability and flexibility
  • Comfortable working in fast-paced environments
  • Computer literacy and proven track record of working in multiple systems in parallel
  • Phone skills, including familiarity with complex or multi-line phone systems

Estimated Salary

$45,000 - $60,000 per year, depending on experience.



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