Administrative Aide- OMI (Hybrid/Remote)
University of Illinois Urbana-Champaign, IL - Urbana, IL
posted 6 days ago
About the position
Under the supervision of the Assistant Director of Clinical Review, the Administrative Aide will assist the Clinical Review team with data entry and provider communication for Medicaid prior authorization and clinical reviews, post-payment reviews, and other utilization management strategies. The Administrative Aide will utilize their knowledge and experience to ensure Medicaid prior authorization and clinical review requests meet the specific state requirements. HFS is Illinois' single state Medicaid agency and the state organization responsible for administering Illinois' Medical Assistance and Child Support programs. The University of Illinois is an Equal Opportunity, Affirmative Action employer. Minorities, women, veterans, and individuals with disabilities are encouraged to apply.
Responsibilities
- Assist with data entry and eligibility verification for administrative reviews, providing consistent entry information on the clinical review process.
- Implement administrative utilization management (UM) processes.
- Uses knowledge of Medicaid services and UM processes to support providers who have process, policy or procedure questions.
- Consults with Clinical Review Coordinator to locate answers to complex policy questions. Identifies issues and discusses strategies for meeting standards.
- Identifies providers who need extra support and initiates communication with providers in partnership with Clinical Review Coordinator.
- Maintains email, phone and in-person communications with statewide providers, for technical, procedural, and policy support related to utilization management.
- Implement and review date tracking to ensure service-level agreement (SLA) timelines remain within compliance.
- Maintains the SLA compliance report.
- Other duties as assigned.
Requirements
- High school graduation or equivalent.
- Any one or any combination totaling five (5) years (60 months) from the following categories: college course work in business, finance, accounting or a related field: 60 semester hours or an Associate's degree equals one (1) year (12 months) 90 semester hours equals two (2) years (24 months) 120 semester hours or a Bachelor's degree equals three (3) years (36 months) Master's degree or higher equals four (4) years (48 months) progressively more responsible general or specialized office experience which included aspects of supervising staff or a job function, organizing, and performing duties that lead to knowledge of generally accepted office principles.
Nice-to-haves
- One year of healthcare experience and/or prior authorization, or Utilization Management experience.
Benefits
- Health, Dental, Vision, Life, Disability & AD&D insurance
- Defined benefit pension plan
- Paid leaves such as Vacation, Holiday and Sick
- Tuition waivers for employees and dependents
