Utilization Review Clerk

Lifepoint Health • Avondale, AZ

3d

About The Position

Your experience matters Copper Springs is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Utilization Review Clerk joining our team, you’re embracing a vital mission dedicated to making communities healthier ®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve. How you'll contribute A Utilization Review Clerk who excels in this role: Obtains prior authorizations and ensures all medical services, procedures, and medications meet insurance requirements prior to delivery. Serves as a key liaison between Clinical Intake and UR Specialists to help prevent coverage gaps.

Requirements

• Education: High school diploma required. Two years of experience in a behavioral health setting may substitute for an associate or bachelor’s degree. An associate or bachelor’s degree in a health-related field is preferred.
• Experience: Background in a medical setting with experience in insurance coordination, verification, medical terminology, case manager, discharge coordinator or behavioral health setting.
• Technical Skills: Proficiency with EMR systems (Meditech or Medik), Microsoft Office applications (Excel, Outlook), and insurance portals such as Availity, AZ Complete, and Optum Star.
• Abilities: Ability to manage high-volume cases, in a high stress environment by completing time sensitive requests and effectively resolve authorization denials.
• Schedule : Monday – Friday

Nice To Haves

• An associate or bachelor’s degree in a health-related field is preferred.

Responsibilities

• Complete Precerts for IP & OP/Secure Authorizations: Initiate and secure pre-authorizations for inpatient and outpatient services through insurance portals, phone, or fax.
• Insurance Verification: Confirm patient eligibility, benefits, and coverage limits with the business office before precerting.
• Communicate all updates or status changes directly to the UR Specialist and document that information in the EHR.
• Documentation & EHR Management: Update Meditech with approval numbers, status updates, and denied dates of service.
• Upload and attach authorization approvals or denials to OnBase MR & scan completed packets to UR the Share drive.
• Complete prior authorization request documentation for major payers, including Banner, Health Choice, Molina, Allwell, Wellcare, and Cigna.
• Record Keeping: Maintain detailed insurance logs and ensure all patient chart documentation in Meditech remains current.
• Departmental Support: The UR Manager may assign other UR related task to be completed as needed.

Benefits

• Comprehensive Benefits : Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Financial Protection & PTO : Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth : Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being : Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development : Ongoing learning and career advancement opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED