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Health Care Services Specialist II
Department: Health Care Services
Salary level: 3
Position Summary :

• Conduct administrative functions for the Health Care Services Administration team; and to serve as a backup with any other duties needed
• Provide general administration support to the Health Care Services department (ie: management, clinical & data analytics teams)
• Maintain and follow department policy and procedures as required
• Maintain and ensure URAC standards, criteria, and guidelines

Essential Duties & Responsibilities:

• Handle inbound and outbound telephone calls (ie: prior authorization status inquiries, research of ICD, CPT, & HCPCS codes)
• Discuss inquiries with other staff and/or departments to resolve any issues
• Request additional clinical notes as needed
• Retrieve messages from the telephone answer service and add messages to the Voicemail Spreadsheet
• Assist with non-clinical review of prior authorizations, data entry, and proper process for clinical review
• Retrieve electronic files/faxes
• Assign to the appropriate staff, prior authorization file and/or designated folder
• Open, scan and distribute mail
• Coordinate meetings and conference calls by confirming availability of all participants as well as availability of conference room or offsite facility
• Electronic filing of completed member records and/or any other miscellaneous documentation
• Process and distribute HCS Daily Reports to the HCS clinical & non-clinical staff
• Process incoming drug request overrides (via phone or fax) by determining validity of the request; if not sent to the PBM
• Process & distribute the daily Inpatient Hospital Census Report to the clinical team
• Acquire hospital discharges daily
• Serve as a backup to HCS Specialist III to generate all administrative team letters (ie Approvals, Denials, Partials, LOIs, etc)
• Generate and process the Invalid Seen Date report
• Update the system as necessary or return the file to the proper HCS staff to make corrections
• Assist with the creation, updating and revising of Health Care Services educational materials as necessary, including PowerPoints or other materials
• Accurately maintain and update department policies and procedures, performing Quality Control (QC) reviews as necessary
• Perform other duties and/or projects as assigned by the HCS Supervisor or management
• Request for additional duties or to be crossed trained in other duties when workload permits
• This Position prohibits any activity that requires interpretation of clinical information to customers, including the choosing of a set of criteria to use for handling a request for healthcare services or treatment

Required Education and Experience:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Two years of previous administrative or clerical experience, preferably in a health care related setting
• High School diploma or equivalent

Preferred and Advanced Qualifications:
Associates degree from an accredited university/college
CPC (Certified Professional Coder) designation is desired
Administrative or clerical experience in a health care related setting
Physical Demands/Working Conditions:
The work environment characteristics described here are representative of those associate encounters while performing the essential functions of this job.

• Requires frequent standing, sitting, stooping, walking, seeing, hearing, speaking
• Wearing of headsets required when answering phones
• This position is eligible to work from home and will rotate with team to work in the office to complete administrative tasks

Competitive compensation & excellent benefits offered
Visit our website at https://uhahealth.com/page/career-opportunities to apply and for details about vacant positions.
An Equal Opportunity Employer