Non-Clinical UM Administrator

Non-Clinical UM Administrator Alacura Medical Transportation Management, LLC Dallas, TX Job Details Full-time $35,000 - $45,000 a year 20 hours ago Benefits Health insurance Dental insurance 401(k) Paid time off Vision insurance 401(k) matching Life insurance Qualifications Teamwork Interpersonal skills Phone communication Data entry Manual handling Time management Client interaction via phone calls Full Job Description

POSITION TITLE

Intake Specialist/Non-Clinical UM Administrator

START DATE

TBD

SCHEDULE

Monday - Friday; 8a-5p / 9a-6p / 10a-7p

DEPARTMENT

Alacura

UM REPORTS TO

VP of Utilization Management Summary:

The Intake Specialist is responsible for managing various aspects of inbound data entry requests for medical necessity reviews. This includes obtaining intake data for authorization requests, attaching medical records, communicating with external parties, and coordinating with Alacura Transfer Center Operations. The role demands precision, regulatory compliance, and exceptional customer service skills to ensure efficient and accurate processing.

Relationships:

Interfaces To:

Initial Clinical Reviewers, UM Nurses, Peer Reviewers, coworkers, providers, and customers

Supervises:

None Essential Duties & Responsibilities:

Medical Necessity Request Intake Documentation:

Accurately handle inbound requests for air and ground medical transportation utilization management authorizations, maintaining detailed records of all interactions and transactions.

Regulatory Compliance:

Ensure compliance with all relevant regulations and guidelines in processing authorization requests, noting no medical interpretation will be required from non-medical licensed employees.

Customer Service:

Deliver outstanding customer service by promptly addressing inquiries and resolving issues. Transfer or escalate medical calls requiring review and interpretation of medical data to an RN.

Understand Stakeholders:

Comprehend the logistical and emotional positions of case managers, hospitals, social workers, patients, and family members.

Collect Data:

Gather comprehensive data to initiate authorization requests efficiently.

Monitor Mailings:

Monitor outbound mailings for benefit determination notifications, ensuring adherence to regulatory timelines.

Adaptability:

Adjust to frequently changing workloads and interruptions.

Training Support:

Assist in the training of new team members on intake procedures and best practices, fostering a collaborative learning environment.

Administrative Duties Team Collaboration:

Utilize the department team to discuss, enhance, and resolve issues.

Process Improvement:

Identify and recommend improvements to intake processes to enhance efficiency and accuracy.

Maintain Documentation:

Assist in maintaining procedure manuals.

Special Projects:

Perform other non-clinical duties and special projects as assigned.

Qualifications:

Required:

•

Education:

Associate degree or equivalent; additional education in healthcare administration or related field preferred

Experience:

1-2 years in healthcare with knowledge of health and insurance plans.

Knowledge, Skills and Abilities:

Ability to navigate computerized systems and relevant applications while interacting with representatives on the phone. Courteous and polite telephone skills. Critical thinking and resourcefulness. Superior verbal and written communication skills. Flexibility and patience when speaking with difficult representatives. Excellent discretion, judgment, probing, and problem-solving skills. Effective time-management skills. Ability to absorb and apply new and changing information. Commitment to providing superior quality customer service.

PHYSICAL DEMANDS

Physical demands described here are representative of those that must be met by an employee to successfully perform essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions. While performing duties of this job, the employee is frequently required to sit. The employee is occasionally required to stand, walk, climb, or balance, stoop, kneel, crouch or crawl, reach with hands and arms, use hands to finger, handle or feel, talk, hear and smell. The employee is required to maintain adequate physical conditioning to be able to perform job duties. Job duties are often performed at high stress levels requiring employees to function effectively and independently while maintaining good working relationships with partners, employees, and customers. The employee may frequently lift and/or move up to 25 pounds and may occasionally lift and/or move between 26‐100 pounds. There are no specific vision abilities required to perform this job.

WORK ENVIRONMENT

Employee shall typically be working from a home environment. Alacura provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Job Type:

Full-time Pay:

$35,000.00 - $45,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

Hybrid remote in Dallas, TX 75243