Utilization Management Processor Job at Avesis, Incorporated
Join us for an exciting career with the leading provider of supplemental benefits!
Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.
Is a culture where “People Count,” “We Do the Right Thing,” and “We Hold Ourselves to Very High Standards” important to you? If so, Avesis is seeking a processor role within our organization. As a UM Processor, you will be responsible for timely and accurate review of vision preservice requests and ensure they meet federal, state, NCQA or contractual requirements. You will perform first level review of prior authorizations based on a member’s eligibility, covered services outlined for each client contract and clinical pathways provided by our clinical team. In addition, finalize administrative approvals, denials and/or finalize adverse determinations made by our clinical team. You will interact with and help educate our provider network to ensure quality care for our membership.
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.
Essential Job Functions:
- Understand and uphold of Avesis’ policies and procedures relative to the UM reviews required by each client contract.
- Conduct reviews of prior authorizations by providers to either authorize the recommended treatment, in accordance with Avesis UM procedural guidelines, or to refer the case to a Clinical Director or consultant for a professional clinical review.
- When reviewing authorizations; if insufficient information is required, perform outreach to providers for correction and resubmission.
- Document approvals or denials of treatment in accordance with prescribed UM department procedural guidance and forward applicable files to the client health plan as required by each contract.
- Maintain a daily level of productivity in accordance with departmental requirements for production and quality standards.
- Maintain effective intradepartmental communications through sharing of plans, general company news and other information through informal interactions and routinely held departmental meetings.
- Shows a high level of dedication to a commitment to excellence, working hard to deliver on commitments to others and ensure quality of care.
- Other duties as assigned.
Requirements:
- Minimum 2 years' experience in dental benefit administration or similar role.
- High School Diploma or GED is required. Bachelors’ or Associate’s degree in dental, medical fields preferred but not required.
- Certification as a dental assistant and/or x-rays is highly preferred.
- Ability to review and understand dental x-rays, models, photos, and patient charts required.
- Ability to manage multiple tasks, prioritize work and adaptable to change when necessary.
- Excellent written and verbal communication skills required.
- Proficient windows-based computer skills and skills in navigation and use of MS Office suite applications.
We Offer
- Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
- Competitive compensation package.
- Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
- Life and disability insurance.
- A great 401(k) with company match.
- Tuition assistance, paid parental leave and backup family care.
- Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
- Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
- Employee Resource Groups that advocate for inclusion and diversity in all that we do.
- Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.
Equal Employment Opportunity
At Avēsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic. At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avēsis, where We See You!
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