Top 15 Authorization specialist Jobs in Papillion Ne

Utilization Review Specialist
Berkshire Hathaway Homestate Companies —Omaha, NE
- Hybrid work
- Basic math
- Research
- Office
Quick Apply
14d
Patient Access Specialist- Part Time
Boys Town National Research Hospital —Omaha, NE
- Part-time
- Surgery
- Clinic experience
- 3 years
- Health insurance
- Tuition reimbursement
13d
Patient Support Specialist
Total Respiratory & Rehab —Omaha, NE
- Overtime
- Background check
- Microsoft Outlook
- Ability to walk for extended periods
Quick Apply
Client Support Specialist II
Farm Family —Omaha, NE
- Overtime
- Mid-level
- Office
- High school diploma or GED
- Health insurance
- Dental insurance
Lead Specialist, Personal Banking
First National Bank of Omaha —Omaha, NE
- $41,116 - $65,787 a year
- Email
- Remote
- Mid-level
- Criminal background check
- Travel
- Health savings account
- Disability insurance
9h
Specialist, Customer Identified Fraud & Disputes Contact Center - $20 (Omaha)
First National Bank of Omaha —Omaha, NE
- $20 an hour
- Email
- Office
- High school diploma or GED
- US work authorization
- Health savings account
- Disability insurance
6d
Customer Service Specialist
Amber Specialty Pharmacy —Omaha, NE
- From $19 an hour
- Full-time
- Background check
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
3d
CMN Coordinator
Kubat HealthCare —Omaha, NE
- $19 - $21 an hour
- Full-time
- HIPAA
- Mid-level
- High school diploma or GED
- Paid holidays
- Dental insurance
Quick Apply
5d
Medical Assistant
Concentra —Omaha, NE
- Full-time
- Microsoft Excel
- Vital signs
- Microsoft Outlook
- Commuter assistance
- Disability insurance
13d
Medical Assistant
One to One Health —Council Bluffs, IA
- PRN
- Customer service
- Computer literacy
- Writing skills
Quick Apply
Behavioral Health Patient Navigator
All Care Health Center —Council Bluffs, IA
- $18 - $23 an hour
- Monday to Friday
- Spanish
- Vital signs
- BLS Certification
- Paid holidays
- Disability insurance
Quick Apply
Patient Access Specialist
Boys Town National Research Hospital —Omaha, NE
- Full-time
- Surgery
- Medical office experience
- 3 years
- Health insurance
- Tuition reimbursement
13d

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Utilization Review Specialist

Berkshire Hathaway Homestate Companies -
Omaha, NE

Quick Apply

Job Details

14 days ago

Qualifications

Basic math
Employee relationship building
Productivity software
Technical Proficiency

Full Job Description

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an opening for a Utilization Review Specialist in Omaha to join its Medical Management team. The individual ensures that medical treatment requests from providers are medically appropriate and reviewed in compliance with State laws and Company policies.

ESSENTIAL RESPONSIBILITIES

Triages and manages intake coordination of requests for authorization and independent medical review requests.
Reviews authorization requests for approval in accordance with evidence-based medical treatment guidelines.
Researches claim files in relation to the requested medical treatment, interprets medical reports while utilizing critical thinking, and applies appropriate established guidelines to requested treatment.
Advocates for the injured worker and Claims department, ensuring proposed treatment requests are appropriate for the diagnosis.
Escalates treatment requests outside of authorization authority for review by a Utilization Review Specialist 2 or Utilization Review Nurse.
Ensures that utilization review processes are performed in accordance with the time limits and other requirements set by State law and Company policy.
Routinely contacts providers to clarify treatment requests and examination findings, as well as to obtain additional medical information as needed.
Gains and Maintains a thorough understanding of Company policies regarding the review of authorization requests by Utilization Review Specialists.
Establishes and maintains a close, positive communicative relationship and working partnership with Medical Bill Review staff to ensure effective and efficient integrated medical management of treatment provided to injured workers.
Fosters a positive and close working relationship with other Company staff, including adjusting staff, other Medical Management staff, Special Investigations Unit, Legal, Liens, Customer Care, and Client Services.
Maintains patient confidentiality and safeguards protected health information in accordance with State and Federal laws and Company policies.
Enters clear, concise, and accurate documentation of requested medical treatments, to include clinical findings, treatment guidelines, and determinations.
Ensures that appropriate notices are forwarded to medical providers, injured workers, Claims staff, and attorneys.
Provides general office or administrative support throughout the department.

QUALIFICATIONS

EDUCATION: Bachelor's or Associate's degree in a medical field from an accredited college or technical school required.
EXPERIENCE: Minimum of 6 months of relevant experience and/or training in a medical field, or equivalent combination of education and experience, required.
TECHNICAL SKILLS: Able to effectively use Microsoft Office/365 applications and able to become proficient in proprietary and vendor software applications.
LANGUAGE ABILITY: Able to read and understand basic documents, including statutes, regulations, medical records, medical bills, medical resource materials, claim notes, and claim data fields. Able to write clear, concise reports accurately conveying complex and nuanced information, as well as correspondence on medical and legal points. Able to effectively present information and respond to questions with adjusting staff, Management, and others.
MATH AND REASONING ABILITY: Able to solve practical problems and deal with a variety of variables in situations where only limited standardization exists. Able to interpret a variety of instructions furnished in written, oral, diagram, graph, or schedule form. Able to apply concepts such as addition, subtraction, multiplication, division, fractions, percentages, ratios, and proportions to practical situations. Ability to derive appropriate conclusions and apply on the job.

CORE COMPETENCIES

ATTENTION TO DETAIL

Double-checks the accuracy of information and work product to provide accurate and consistent work.
Completes all work according to procedures and standards.
Works in a conscientious, consistent, and thorough manner.

COMMUNICATION

Communicates and articulates clearly; is informative and appropriately concise.
Asks questions freely to broaden knowledge and skills.
Prepares clear and concise e-mails and other basic required written communications.

PROBLEM SOLVING & DECISION MAKING

Is objective; is able to evaluate facts apart from personal bias.
Identifies key decisions within area of responsibility and escalates tasks to appropriate authority as needed.
Effectively uses appropriate decision-making techniques.

Quick Apply

Refine Your Search

authorization specialist jobs in papillion ne

Utilization Review Specialist

Patient Access Specialist- Part Time

Patient Support Specialist

Client Support Specialist II

Lead Specialist, Personal Banking

Specialist, Customer Identified Fraud & Disputes Contact Center - $20 (Omaha)

Customer Service Specialist

CMN Coordinator

Medical Assistant

Medical Assistant

Behavioral Health Patient Navigator

Patient Access Specialist

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