OPS UM Program Assistant
Job no: 506078
Work type: Temp Full-Time
Location: Main Campus (Gainesville, FL)
Categories: Administrative/Professional, Office/Clerical
Department:29092200 - MD-PEDS-ICS
||OPS UM Program Assistant
- Processing of requests for medical review authorizations requiring medical director approval, ensuring that all clinical notes and appropriate documentation are included and that all contractual time requirements for responses are met. Documenting all events related to each step in the medical review process as they occur. Alerting medical directors of upcoming medical review decision deadlines. Keeping MED3OOO/McKesson notified about the status of medical reviews at each step of the process. Reviewing member electronic folders, documents, and logs to ensure all aspects of the medical review process have been successfully completed.
- Contacting providers to request additional information, drafting Ped-I-Care extension and decision letters and sending such letters to families, providers, and CMS Nurse Care Coordinators (NCCs) within contractual time frames.
- Assisting the Assistant Director for UM and Administrative Services Specialist II with general administrative support, including collecting information, preparing submittals, scheduling and transcribing meetings, analyzing Utilization Management data from reports issued by MED3OOO/McKesson, assisting with audits in connection with Ped-I-Care's UM processes, and assisting with Plan Appeals as needed.
- Other employment duties as assigned.
$15.00 - $18.00 hourly commensurate within this range based on experience and education
A high school diploma and four years of appropriate experience. Appropriate college coursework or vocational/technical training may substitute an equivalent rate for the required experience.
- Experience with AHCA/Medicaid regulations relating to health service contracts
- Experience in physician and/or hospital billing, claims processing and reimbursement, or working with a health care plan
- Experience with medical referral or authorization requests
- Proficiency in Microsoft Office (Word, Excel, Outlook, and Access)
- Medical Terminology
- Medicaid Handbooks & Fee Schedules
- Strong Organizational Skills
|Special Instructions to Applicants:
Applicants must apply via Careers at UF. To be considered for this position, please include a cover letter, your CV or resume, and a list of at least three professional references.
Application must be submitted by 11:55 p.m. (ET) of the posting end date.
This requisition has been reposted. Previous applicants are still under consideration and need not apply.
|Health Assessment Required:
Advertised: Eastern Standard Time
Applications close: Eastern Standard Time
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