AddressThank you for considering Progyny!
Progyny is looking for a Utilization Management Associate to join our team. This associate will be responsible for multiple administrative tasks to support the Utilization Management Clinical Coordinator and our Chief Medical Officer. The ideal candidate possesses strong attention to detail, excellent verbal, and written communication skills, is task driven, and will have basic fertility treatment knowledge.
What you'll do...
- Process all incoming and outgoing correspondence/faxes in accordance with required standards and within respective timeliness guidelines.
- Assist with initial screening of authorization requests.
- Generate and send emails using mail merge templates.
- Manage a multi-step workflow including data entry and validation.
- Schedule and organize meetings, including logistics, attendees, and materials.
- Handle exporting various files in the required formats while ensuring data integrity.
- Assist with tracking daily, weekly, and quarterly reporting in coordination with all service level agreements for Progyny federal and non-federal clients.
- Coordinate and schedule coverage for general clinical UM case review as well as peer-to-peer review and appeal appointments between our physician reviewers & network providers within necessary timelines; track and record quarterly compensation/reimbursement.
- Coordinate with an Independent Review Organization to ensure the regular auditing of utilization case management for specific states.
- Support Member and Provider Services by assisting in various TEAMS groups and creating, updating, and distributing applicable content.
- Communicate and escalate potential enhancements to both internal and external processes.
- Categorize documentation while remaining in accordance with PHI (Protected Health Information) / HIPAA (Health Insurance Portability and Accountability) restrictions.
- Diligent monitoring of peer-to-peer and appeal case request to guarantee that all tasks are finalized within the required turnaround period.
About you...
- Experience working in a fertility clinic and possess basic fertility knowledge.
- Knowledge of CPT, HCPCS, ICD-10 codes and understanding of medical terminology
- Effective communication and presentation skills.
- Strong attention to detail.
- Excellent written and verbal communication skills.
- Capable of managing multiple tasks simultaneously.
- Ability to communicate effectively and thoughtfully with providers regarding authorization requests and determinations.
- Ability to work independently with minimal supervision and to escalate when necessary.
- Strong multi-tasking and prioritization skills
- Experience working with CRM platforms (specifically Salesforce) and reporting / dashboard management.
- Experience working with Microsoft Office Suite (Work, Excel, PowerPoint, Outlook)
About Progyny:
Progynyis a transformative fertility, family building and women's health benefits solution, trusted by the nation's leading employers, health plans and benefits purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive, inclusive and intentionally designed solutions simultaneously benefit employers, patients and physicians.
Our benefits solution empowers patients with concierge support, coaching, education, and digital tools;provides access to a premier network of fertility and women's health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs.
Our mission is toempower healthier, supported journeys through transformative fertility, family building and women's health benefits.
Headquartered in New York City, Progyny has been recognized for its leadership and growth. Come join a company that has been recognized by CNBC Disruptor 50, Modern Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times, INC. 5000, Inc Power Partners and Crain's Fast 50 for NYC.
Our perks:
- Family friendly benefits: Paid family and parental leave-, fertility and family building benefits (including egg freezing, IVF, and adoption support), family care fund and Parents' Employee Resource Group
- Health, dental, vision and life insurance options for employees and family
- Free in-person, virtual and text-based mental health and wellness support
- Paid time off, including vacation, sick leave, personal days and summer flex time
- Company equity
- Bonus program
- 401(k) plan with company match
- Access to on-demand legal and financial advice
- Company social events
- Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting intoour NY office
In compliance with New York City's Wage Transparency Law, the annual salary range for NYC-based applicants is: $65,000 - $80,000. There are a variety of factors that go into determining a salary range, including but not limited to external market benchmark data, geographic location, and years of experience sought/required. Progyny offers a total compensation package comprised of base salary, cash bonus, and equity.
Progyny is proud to be anEqual Opportunity and Affirmative Action employer.We respect and seek to empower each individual and support the diverse cultures, perspectives,skillsand experiences within our workforce. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability, age, genetic information, marital status, pregnancy or related condition, status as a protected veteran, criminal history consistent with legal requirements or any other basis protected by law.
If you are an individual with a disability and need assistance or an accommodation during the recruiting process, please send an e-mail to .
Minimum Salary: 31200.00 Maximum Salary: 31200.00 Salary Unit: Yearly
