Utilization Review Support Specialist-2
About The Position
Provides administrative support to the Utilization Review Team and assists with eligibility verification, data entry, and coordination of information. Coordinates with external healthcare providers, payors, patients, and internal teams to obtain and provide necessary account information. Serves as a liaison for inquiries and issues regarding authorizations, denials, and utilization reviews. Manages incoming and outgoing telephones, emails, and faxes. Monitors and completes multiple work queues. Maintains accurate and complete documentation of admission authorizations and other utilization review information. Reports utilization review progress to leadership and ensures compliance with contractual standards and regulations. Participates in quality improvement initiatives to enhance utilization review processes.
Requirements
- High School Diploma or equivalent, required.
- One year of experience in hospital setting or medical office, required.
- Working knowledge of medical terminology, general medical office procedures, and HIPAA regulations.
Nice To Haves
- Associate's Degree, preferred.
- Experience with CPT, ICD-10 and HCPCS coding, preferred.
- Two years of managed care experience including experience in a call center, preferred.
Responsibilities
- Coordinates with external healthcare providers, payors, patients, and internal teams to obtain and provide necessary account information.
- Serves as a liaison for inquiries and issues regarding authorizations, denials, and utilization reviews.
- Manages incoming and outgoing telephones, emails, and faxes.
- Monitors and completes multiple work queues.
- Maintains accurate and complete documentation of admission authorizations and other utilization review information.
- Reports utilization review progress to leadership and ensures compliance with contractual standards and regulations.
- Participates in quality improvement initiatives to enhance utilization review processes.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
