Administrative Support Professional (Asheville, NC)

LOCATION: Asheville, NC - this is an office-based position in Asheville, NC. Incumbent in this role must live in North Carolina or within 40 miles of the NC border.

GENERAL STATEMENT OF JOB

This position provides program assistance and administrative support for the Utilization Management team. This position involves extensive work using the Administrative Health Record system(s) to coordinate care for members, beneficiaries and recipients transitioning to and from Vaya's Health Plans and managing referrals to delegated UM vendors. In addition, the employee participates in collecting and monitoring various forms of data. The employee also interacts with members, recipients, beneficiaries, providers, stakeholders, vendors, NC Department of Health & Human Services, and the public by providing information and other forms of assistance. The employee provides an array of administrative support services to teams within Utilization Management including meeting scheduling, recording notes and minutes, and organizing document storage. This position may also provide assistance as necessary with the Transition of Care process.

ESSENTIAL JOB FUNCTIONS

Administrative Assistant for Utilization Management/Appeals:

The position provides administrative coordination and support to help maintain, evaluates, and improves Utilization Management functions, including the management of departmental communications (e.g., email inbox, fax, and phone line/voicemail, etc.), the coordination of departmental business process, including annual internal reviews, participation in Utilization Management meetings, and development and distribution of minutes and training materials as needed.

This position shares responsibility for managing the Peer Review Desk as part of the clinical peer reviews conducted during the Utilization Management review process for service authorization requests.

• Gathers information for referral to peer reviewer
• Organizes, sends, and tracks all assigned peer reviews to ensure timeliness of completion
• Gathers completed reviews from delegated vendors and formats decisions for members' administrative health records
• Communicates with the Member Appeals Team regarding Peer Review Desk functions

This position provides support for transition of care for Vaya's members and beneficiaries by ensuring that people transitioning to and from Vaya's Health Plan experience seamless transitions of care. Primary duties are as follows:

• Liaise with Standard Plan (SP) Prepaid Health Plans (PHPs), other Tailored Plans (TPs), and Tribal Option Plan
• Review prior authorizations from former insurers and ensure that UM enters authorizations to honor these
• Ensure that Out of Network Agreements are executed timely to ensure continuity of care
• Obtain appropriate releases of information to support continuity of care when members transfer to and from Vaya's plan
• Outreach new members transitioning from another PHP, TP, or Tribal Option Plan
• Respond timely to requests for information from other insurers or vendors
• Ensure that Vaya sends appropriate documentation for high acuity members transitioning to another plan to the receiving plan

Administrative Support for Utilization Management:

This position supports the RN UM Clinician Supervisor and other UM leadership and staff by providing administrative and clerical functions, including support for administering Value Added Services. The employee maintains files and provides support for projects as needed. This position collects data as requested to help maintain, coordinate, and evaluate Utilization Management functions. The employee schedules, hosts, and participates in Utilization Management meetings, and develops and distributes information/minutes as needed. The employee interacts with members, beneficiaries, recipients, stakeholders, providers, vendors, and the public in providing information and addressing their questions and concerns. The employee distributes mail, monitors fax accounts, and provides coverage for staff as requested.

Documentation & Audit Preparations

This position prepares documentation for reviews and audits as needed, compiling, and uploading data as specific reviews dictate.

Other Duties

Other Duties as assigned.

KNOWLEDGE, SKILL & ABILITIES

This position requires excellent verbal and written skills. Additionally, it requires familiarity with a wide variety of software packages and the Administrative Health Record(s). Strong people skills are required to promote excellent communication with staff at all levels, members, and the general population. This position requires skill in organizing workflow. Ability to analyze and interpret policy and procedural guidelines is necessary. Intermediate level Microsoft Office software proficiency is required.

QUALIFICATIONS & EDUCATION REQUIREMENTS

High school diploma or equivalent and 4-5 years of progressively responsible secretarial or clerical/administrative/office management experience

OR

Two-year secretarial science or business administration program and 2 years of progressively responsible secretarial or clerical/administrative, office management experience

OR

Completion of a four-year program in a college or university preferably with major emphasis on coursework in business administration, public administration, or other related field; 1 year of experience.

Preferred work experience:

Experience and/or education in the healthcare field is a plus, but not required.

MENTAL/PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border.

SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open Until Filled

APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.

Vaya Health is an equal opportunity employer.