Utilization Review Specialist

Athens Administrators • Orange, CA

20h • Remote

About The Position

Athens Administrators is hiring a full-time Utilization Review Specialist to support its Managed Care department. The role may be performed remotely if the employee meets technical requirements and resides in a state where Athens operates. The schedule is Monday through Friday, 9:00 a.m. to 5:00 p.m. Pacific time, with a 30-minute meal break, totaling 37.5 hours per week.

The specialist assists with the utilization review process through data collection of demographic, claim, and medical information; non-medical analysis; and outcomes reporting. The position involves substantial data entry, managing authorization requests and workflow, communicating professionally with callers and email contacts, and following regulatory, privacy, and security requirements. The position reports to the Utilization Review Clinical Supervisor. The next career progression step may be Utilization Review Specialist II.

Requirements

• High school diploma or GED.
• At least one year of data-entry experience; experience in the medical or insurance industry is preferred.
• At least one year of customer service experience.
• Time-management skills and ability to work independently to meet goals and sensitive timelines.
• Well-developed verbal and written communication skills, with strong attention to detail.
• Strong organizational skills and ability to multitask.
• Ability to type quickly and accurately for prolonged periods.
• Proficiency in Microsoft Office Suite and ability to learn additional computer programs.
• Reasoning, problem-solving, and analytical skills, including the ability to research and analyze facts, identify issues, and recommend appropriate solutions.
• Trustworthiness, dependability, and ability to work as a team-oriented contributor.
• Commitment to service and results, and ability to use innovative strategies and methods.
• Ability to show care and concern for team members and clients in a professional and friendly manner, and to act with integrity in difficult or challenging situations.
• Ability to maintain honesty and integrity while handling confidential, proprietary, and highly sensitive information.

Nice To Haves

• Associate of Arts/Associate of Science or Bachelor of Arts/Bachelor of Science degree.
• One year of work experience in a corporate environment.
• Knowledge of basic medical terminology and ICD-9/10, or ability to learn and apply them.

Responsibilities

• Enter initial data and initiate workflow processes.
• Initiate and modify demographic, physician, and facility information, and quality-check data-feed information.
• Validate that authorization requests are complete or request additional data from the requesting physician when necessary.
• Run authorization requests through the rules engine for direct approval.
• Assign cases that do not meet criteria for direct approval to the next-level reviewer.
• Answer general phone calls and emails professionally and direct them to the appropriate party as needed.
• Complete projects and tasks assigned by management.
• Follow regulatory policies and procedures, privacy requirements, and security standards, including HIPAA requirements.
• Perform other duties as assigned.

Benefits

• Medical, vision, and dental plans.
• Life and accidental death and dismemberment insurance.
• Long-term care, critical care, accident, and hospital indemnity coverage.
• Health Savings Account and Flexible Spending Account options.
• 401(k) and Roth options.
• Company-paid short-term and long-term disability insurance.
• Eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments.

What This Job Offers

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