Clinical Ops Specialist - 40328SH - (US-IN-Indianapolis - 46298)

Minimum Education: Tech School
Job Type: Full Time
Email this job to yourself or to a friend | Job Match Test | Resume Guide

WellPoint
is the nation's leading health benefits insurer and a Fortune Top 50 company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to be the most trusted choice for consumers and a leader in affordable quality care with an unyielding commitment to meeting the needs of our diverse customers.
Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.



Responsible to coordinate non-clinical utilization management (UM) activities. Coordinates and collaborates with internal and external resources to support UM efforts. Primary duties may include, but are not limited to: Actively collaborates with external providers to facilitate care for members under the direction of a nurse. May request medical records from providers and/or communicate authorization decisions. May coordinate incoming faxes/file/maintain records to support the clinical review process. May complete and submit referrals to appeals, health initiatives, or other programs. Maintains and updates tracking databases. Prepares UM reports, documents all actions in UM mainframe application and provides administrative support for UM. Handles escalated and unresolved calls, issues or correspondence for less experienced staff. Initiates and resolves complex problems requiring technical expertise. May provide quality control services. Develops, recommends and implements training for other staff members. May be assigned to special projects. Requires high school diploma and 2 years of related experience, or any combination of education and experience, which would provide an equivalent background. Excellent communication and customer service skills required. Ability to work effectively in a cross-functional team environment. Strong computer knowledge, knowledge of Windows-based applications required. For internal candidates, UM Rep II or above preferred.


Skills:
Requires high school diploma and 2 years of related experience, or any combination of education and experience, which would provide an equivalent background. Proficient with WMDS and Mainframe. Experience in UM, intake, prior authorization in SSB strongly preferred. Medical terminology, claims and billing experience preferred. WellPoint is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2008 DiversityInc magazine Top 50 Company for Diversity

To apply copy and paste the link below into your browser:

http://www.asian-jobs.com/view.php?job_id=63158&type=search&auth_sess=ca75d54a34246d5881f2641eacb92efa&ref=c5b677784c10fea48c9ce65e5

There are so many more positions in any industry in all cities and states available on our website. Asian-Jobs.com specializes in jobs for bilingual English/Asian-speaking professionals and applying to all jobs is free. Take a look, there are many wonderful opportunities available. Go directly to www.Asian-Jobs.com