Utilization Management Mail Print Specialist - Texas STAR KidsPrimary Location: Dallas, TX
Additional Locations: TX-Dallas, TX-Ennis, TX-Grand Prairie, TX-Greenville, TX-Irving, TX-McKinney, TX-Plano, TX-Terrell Apply
The Utilization Management (UM) Mail Support Specialist supports comprehensive coordination of medical services including: receiving, sorting, printing and generating incoming letters; processes and sends outgoing letters according to established procedures to Aetna Medical Services Programs. Promotes/supports quality effectiveness of Healthcare Services. This is an office-based position in the Dallas office.
- Performs print, seal, stamp and mailing of all document requests generate by UM team. Utilizes Aetna system to research and retrieve letter information.
- Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
- Promotes communication, both internally and externally to enhance effectiveness of medical management services
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
- Strong attention to detail is required to communicate accurate and detailed specifications to printers.
- Provide expertise on all aspects of print production including cost and time saving measures and quality assurance.
- Track all workflow operations via a shared departmental database.
- Research for missing and/or insufficient information. Maintain production and department records.
- Communicate with Aetna Case Managers, Prior Authorization and Concurrent Review Nurses and Letter Writers for clarification of information when processing letters and materials.
- Uses Aetna Systems such as QNXT, Dynamo, Krames, and iNotify. Sedentary work involving significant periods of sitting, walking, standing and printing.
- Work requires visual acuity to perform close inspection of written and computer-generated documents as well as a PC monitor. Working environment includes typical office conditions.
- Ensures data integrity by correctly reviewing data and reporting any identified discrepancies to a supervisor.
- Gathers, sorts and tracks information as requested to meet daily business needs.
- Identifies and promptly reports any system issues to supervisor for resolution.
- 2-4 years experience as a medical assistant, office assistant or other clinical experience.
- High School Diploma or G.E.D.
- Effective communication, telephonic and organization skills.
- Familiarity with basic medical terminology and concepts used in care management.
- Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel. Strong keyboard and mouse skills required.
- Ability to effectively participate in a multi-disciplinary team including internal and external participants.
- Pediatric/adolescent experience is preferred
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