Utilization Review Tech I - Data Quality

Centinela Hospital Medical Center•Inglewood, CA

About The Position

At Centinela Hospital Medical Center, our dedicated team of professionals are committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, a Top-15 hospital system in the United States, Centinela Hospital Medical Center is actively seeking new members to join its award-winning team! Centinela Hospital Medical Center has been serving the communities of Inglewood and the wider Los Angeles area for 100 years. An award-winning facility, ranking in the top 5% nationally for quality and patient safety, Centinela Hospital is a 362-bed acute-care hospital with a 24-hour STEMI certified emergency department and primary stroke center, orthopedic care, advanced cardiac services, critical care services, inpatient and outpatient rehab programs, and more. Centinela has earned hundreds of national awards and recognitions, including "100 Top Hospital" recognition from Fortune/Merative and straight 'A's (2018-2024) for hospital safety from The Leapfrog Group. For more information, visit www.centinelamed.com. The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. The Utilization review tech will further support the department needs for Release of Information, discharge coordination or other duties as assigned.

Requirements

Minimum one year denials management experience in acute care setting highly preferred.
High School Diploma or equivalent required.
Accurate alphabetic, numeric, and/or terminal-digit filing skills.
Computer data entry with 10-key, with accurate typing speed of 35 wpm required. Excel skills highly preferred.

Nice To Haves

Knowledge of terminal digit filing and medical terminology; preferred.
Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.
Completion of a medical terminology course; preferred.
Background in business and office training; preferred.

Responsibilities

coordinate the utilization review and appeals process as part of the denial management initiatives
coordinating phone calls, data entry and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals
Document and track all communication attempts with insurance providers and health plans
follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers
serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned
support the department needs for Release of Information, discharge coordination or other duties as assigned

Benefits

Centinela Hospital Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs.
Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.

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