Job Description
Utilization Review Admin Technician
REMOTE OR ROCKFORD, IL /
VALUE BASED CARE – CLINICAL OPERATIONS /
FULL-TIME
/ REMOTE
Arcadia is dedicated to happier, healthier days for all. We transform diverse data into a unified fabric for health. Our platform delivers actionable insights for our customers to advance care and research, drive strategic growth, and achieve financial success. For more information, visit arcadia.io.
Why This Role Is Important To Arcadia
In this position you will be bridging the gap between Intake, Utilization Management and Health Plan requirements for data delivery and communication to the medical groups.
What Success Looks Like:
In 3 months
- Train in the different areas of oversight (Intake, UR, IT/Reporting)
- Work on initial data entry
- Work on health record training
- Work on initial introduction to reports and Medical Group Guidelines
In 6 months
- Understand reporting and be familiar with report locations
- Deliver QA reporting feedback to staff
- Have a basic knowledge of rules across all IPA’s
- Understand the Health Plan requirements as outlined in the UM plan and attachments
- Able to assist in quarterly, semi-annual and annual submissions
In 12 months
- Review processes and independently implement opportunities to streamline workflows
- Independently reaches out to staff if requirements are not met, notifying the supervisor if additional coaching is needed
- Development and refinement of job aids to grow the resource pool
What You’ll Be Doing
- Collect defined medical data via various reporting systems
- QA data to ensure accuracy
- Assist in packet review as needed
- Initial review of escalated calls and emails that need Management attention.
- Case entry per Intake Coordinator standards as assigned
- Communicate professionally and develop positive relationships with providers and providers’ support staff
- Maintain confidentiality related to all computer programs, medical records and other data
- Assist in creation and revision of job aids, templates, contact lists, and specialty matrices
- Other tasks, projects or duties as assigned by the supervisor
What You’ll Need To Have
- 1-3 years of experience in healthcare environment, with expertise in multiple EMR software
- Knowledge of medical terminology
- Ability to prioritize daily work, work independently and adapt to change while still meeting timelines and deadlines
- Ability to work effectively with management, co-workers, physicians/nurses, providers and other external agencies/customers
- Experience in Microsoft and Adobe products
- Verbal and written communication skills
- Interpersonal, organizational, and analytical skills
Would Love For You To Have
- Experience in Utilization Review
- Experience in a medical setting
