Senior BPM Associate

3 days ago

Taguig, National Capital Region, Philippines UST USource Full time

UST HealthProof is seeking a Healthcare Utilization Management Intake Analyst. In this role, you will be responsible for supporting the coordination of medical services, including utilization management intake, requesting medical records, and handling provider requests to ensure the effective use of healthcare services. You will play a vital role in promoting and supporting the utilization management team as needed.

  • Provide support services to team members by answering incoming telephone calls, taking messages, researching information, and building authorizations in the Utilization Management (UM) system
  • Request medical records for pending authorizations or continued stay authorizations as necessary
  • Generate UM letters for members and providers when authorizations are not required
  • Refer to necessary services in accordance with the benefit plan
  • Maintain accurate and complete documentation of required information that meets quality standards
  • Protect the confidentiality of member information and adhere to company policies regarding confidentiality
  • Perform other duties as assigned

Required Qualifications

  • High school diploma or G.E.D. required; associate or bachelor's degree in a healthcare-related field an advantage
  • Minimum of one year of experience in a healthcare-related field, with preference for experience in a hospital, medical doctor's office, or health insurance company
  • Experience with medical terminology and concepts used in the healthcare delivery system, provider office, or insurance industry is required.
  • Computer literacy, including proficiency with Microsoft Office products, is required
  • Advanced technical skills for using hardware and software with a high degree of accuracy
  • Excellent oral and written communication skills, with the ability to present clear and concise results
  • Ability to manage significant workload, work efficiently under pressure, and meet established deadlines with minimal supervision
  • Strong time management skills and the ability to prioritize tasks effectively
  • Must demonstrate a high degree of accuracy, efficiency, and dependability
  • Strong customer service skills, with the ability to assist members and providers in understanding healthcare information and coordinating issue resolution
  • Effective written and verbal communication and feedback skills
  • Effective organizational skills, flexibility, and the ability to prioritize tasks as needed
  • Knowledge of educational assessments and learning strategies
  • Proficiency in the use of standard grammar, punctuation, and spelling

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