Case Specialist

Curative - Austin, TX

Full-time

Austin, TX

Personal and Laundry Services

About the position

The Case Specialist plays a crucial role in providing administrative support to the Utilization Management Department. This position is primarily focused on assisting with the denial, appeal, and complaint processes, which are essential for maintaining the integrity and efficiency of the department's operations. The Case Specialist is responsible for handling various reporting functions, screening and assisting with incoming calls, and providing support to the Utilization Management staff as needed. The ultimate goal is to enhance departmental productivity while ensuring that member and provider confidentiality is respected at all times. This role is vital in promoting the mission and philosophy of the organization, ensuring that all tasks are carried out with professionalism and attention to detail. In this position, the Case Specialist will be tasked with typing, mailing, and logging denial, appeal, and complaint letters. They will generate reporting data for health plans regarding denials, appeals, and complaints on a monthly basis, which is critical for tracking and improving service delivery. The Case Specialist will also maintain an organized filing system for all denials, appeals, and complaints, ensuring that information is easily accessible and up-to-date. Additionally, they will accept incoming calls, screening or resolving them in accordance with plan design and authorization requirements, which requires a good understanding of the processes involved. The role also involves entering authorizations for services as delegated, running and distributing reports from VBA databases, and creating and designing forms and reports as needed. The Case Specialist will maintain UM Committee minutes and update UM Policy & Procedures as necessary, ensuring that all documentation is accurate and reflective of current practices. This position may also involve assisting supervisors with special projects and performing other duties as assigned, contributing to the overall efficiency of the department.

Responsibilities

• Types, mails, and logs denial and appeal and complaint letters.
• Generates reporting data for the health plans regarding denials, appeals and complaints on a monthly basis.
• Maintains filing system for denials, appeals and complaints.
• Accepts incoming calls and screens or resolves calls in accordance with plan design and authorization requirements.
• Enters authorizations for services as delegated by assignment.
• Runs and distributes reports from VBA data bases including authorization letters, daily authorization reports sent to health plans, and monthly statistical reports for management.
• Creates and designs forms and reports as needed.
• Maintains UM Committee minutes and updates UM Policy & Procedures as needed.
• Assists supervisors with special projects as needed.
• Performs other duties as assigned.
• Maintains departmental data entry manual and edits content and updates format as needed.
• Maintains files.
• Provides desktop support to the department.

Requirements

• High school diploma or equivalent.
• Previous clerical experience, preferably in a managed care or medical management environment.
• Knowledge of or ability to learn Microsoft Access.
• Knowledge of or ability to learn medical terminology.
• Skill with operating PC and using word processing and spreadsheet software applications.