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Health Management Specialist

  • Location: Birmingham, 35244
  • Salary: 19.0
  • Job Type:Contract

Posted 16 days ago

Remote contract opening for a Health Management Specialist. In this role you will be responsible for ensuring accurate and timely claim adjudication; monitoring and coordination quality initiatives for Health Management claims; gathering and reporting data related to case management and Utilization Management claims functions; and, performing activities that support accreditation and performance standards for the division.

The incumbent is responsible for performing activities in the division that support efficient functioning of the unit (i.e. imaging, faxing, Jiva documentation, Pega indexing, etc.). The incumbent must be proficient at performing multiple tasks for multiple managers.

Additional responsibilities include:

  • Answers questions from the staff and provides guidance regarding payment of claims; Research and work with other areas of the Company to resolve issues related to Case Management, Utilization Management, Healthcare Analytics and Business Support activities of Health Management
  • Completes assigned projects timely and accurately
  • Work with oversight of clinical review staff when performing Utilization Management tasks
  • Learn and maintain knowledge of all Health Management programs (Utilization Management, Business Support, Healthcare Analytics and Case Management)
  • Acts as a liaison between Health Management and other areas of the Company
  • Maintains current knowledge of trends and technology associated with the job
  • Gains knowledge of Utilization Management principles that govern the job
  • Provides feedback and implements new processes to enhance area performance
  • Cross trains with other non-exempt Health Management staff to promote efficiency

Summary of Qualifications:

  • Two years of experience researching and analyzing claims and inquiries
  • Experience in a position interacting with all levels of staff internal and external with minimal supervision
  • Experience in a position interpreting and communicating information orally and written
  • Experience in a position researching and analyzing data, and preparing reports
  • Experience in a position analyzing and identifying process improvements
  • Experience in a position organizing and prioritizing tasks
  • Knowledge of Major Medical, Medicare and Preferred Dental Claims processing systems
  • Jiva experience is preferred
This 9 month contract comes with a full suite of benefits.