Utilization Review Coordinator

Sedgwick•Telecommuter TN, TN

1d•$18 - $19•Onsite

About The Position

To assign utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment.

Requirements

High School diploma or GED required.
Two (2) years of administrative experience or equivalent combination of experience and education required.
Knowledge of medical and insurance terminology
Knowledge of ICD9 and CPT coding
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Detail Oriented
Good interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies

Nice To Haves

Customer service in medical field preferred.
Workers compensation, disability and/or liability claims processing experience preferred.

Responsibilities

Accesses, triages and assigns cases for utilization review (UR).
Responds to telephone inquiries proving accurate information and triage as necessary.
Enters demographics and UR information into claims or clinical management system; maintains data integrity.
Obtains all necessary information required for UR processing from internal and external sources per policies and procedures.
Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary.
Supports other units as needed.
Performs other duties as assigned.
Supports the organization's quality program(s).