Utilization Review Business Support Specialist

Highmark Health • PA, Working at Home - Pennsylvania, PA

2d • $22 - $34

About The Position

This position is responsible for various utilization review support, from initial insurance verification through authorization; including verifying patient benefits and authorization requirements, requesting authorizations, payer communication & follow-up, and processing of incoming payer phone calls and faxes. This role works in tandem with utilization review nurses through their clinical review process to ensure all patients coming into the health system through transfers, direct admissions, and the emergency department have appropriate documentation and authorization for payment by insurance companies.

Requirements

• Bachelor's degree in health care related field or relevant experience and/or education as determined by the company in lieu of bachelor's degree
• 3 years' experience in healthcare environment or related field with exposure to healthcare coding, billing, reimbursement, registration, insurance verification.
• Proficient with Epic
• Proficient with Microsoft Office products
• Strong analytics, organizational, problem-solving, and time management skills
• Ability to work independently
• Excellent written and verbal communication skills
• Excellent attention to detail

Responsibilities

• Ensures accurate and complete documentation and information on all transfers and admissions, following all payer requirements and applicable timeframes related to insurance verification, notice of admission, and authorization. (45%)
• Collaborate with utilization review nurses for timely submission of clinical reviews to payers to obtain authorization for appropriate level of care and length of stay, documenting payer communications in full detail, including all denial details and processes. (35%)
• Identifies payer trends and provides feedback to leadership and necessary parties to mitigate denials and improve payer outcomes. (10%)
• Communicates with all parties in a professional and collaborative manner to achieve optimal outcomes, ensuring confidentiality of all patient accounts by following HIPAA guidelines. (10%)
• Performs other duties as assigned or required.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level