Remote UM Authorization Analyst 2 Bilingual

Note: The job is a remote job and is open to candidates in USA. Starling Oncology is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. As a UM Authorization Analyst II, you will ensure timely and accurate processing of medical procedure authorizations while collaborating with healthcare providers and insurance companies to support patient care.ResponsibilitiesLeading daily huddles with UM Physician Reviewers to address risks related to timely decision-making and documentation accuracyCreating, reviewing, and administering corrective action forms with support and guidance from the Director, Utilization Management ComplianceManaging denial and/or appeal escalations and communicating delays to the Director, Utilization Management ComplianceWorking closely with the Director, Utilization Management Compliance to identify deficiencies and areas for improvementPartnering with delegated entities to ensure the accuracy and compliance of provider credentialing processes, conducting thorough sanction and exclusion checks, and promoting the effective utilization of QuickCap workflows within Utilization Management operationsReporting and Analysis: prepare and present regular reports on authorization activities, including volume, turnaround times, and issuesIdentifying and forwarding standard or expedited appeals to the appropriate health planStaying current on industry regulations, guidelines, and best practices related to utilization management and reviewParticipating in monitoring and analyzing Inter-Rater Reliability (IRR) testing, identifying trends, and recommending best practice improvements to consistent decision-makingDemonstrating expertise in health plan delegation requirements, including Preparation and submission of reports, participate in implementation of corrective action plans (CAPs), updates to policies and procedures, and monitoring and applying regulatory changes to maintain contractual complianceEnsuring adherence to key performance indicators (KPIs) and service level agreements (SLAs) for all delegated Utilization Management (UM) functionsPerforming other duties as assigned to support operational goalsLiving and exemplify Starling Oncology core values, providing outstanding customer service and promoting a positive experience for patients and staff membersSkillsAssociate's degree in health information management, or a healthcare related field4-6 years of experience in utilization managementBilingual in English and Spanish requiredExcellent communication and interpersonal skillsIn-depth knowledge of medical procedure authorization processes and healthcare insurance requirementsAbility to analyze data and implement process improvementsProficiency with medical billing software and electronic health records (EHR) systemsStrong organizational skills and attention to detailStrong understanding of evidence-based guidelines (MCG, National Coverage Determinations, Local Coverage Determinations)Understanding of prior authorization regulatory requirements and turnaround time expectations (CMS, AHCA, NCQA, URAC)Bachelor's degree in health information management, or a healthcare related fieldCompany OverviewFounded in 2007, The Oncology Institute (NASDAQ: TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. It was founded in 2007, and is headquartered in Downey, California, USA, with a workforce of 501-1000 employees. Its website is https://theoncologyinstitute.com. Apply To this Job .