Utilization Review Tech
About The Position
Under direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being responsible for coordinating phone calls, clinical requests, upkeeps data entry, organizes denials and mailing/faxing appeals, tracking data from various insurance providers and health plans regarding authorization and/or denials, expedite reviews and documentation to insurance providers. Monitors patient charts and records to provide to responsible parties and request for authorization for hospital admission. Reviews treatment plans and status of approvals from insurers. Collects and compiles data as required and according to applicable policies and regulations. Performs administrative duties for the Utilization Management Department, and directed in several aspects of duties. Position is non-RN/LVN.
Requirements
- Ability to establish and maintain effective working relationships across the Health System
- Ability to interpret and understand various medical insurance plans and make accurate determinations regarding coverage
- Follow up with insurance companies regarding the status of outstanding claims and necessary steps for resolution
- Answer and review pertinent insurance correspondence to ensure complete and accurate reimbursement for medical claims
- Responsible for working payer correspondence, edits and aged account receivable, and identifying and correcting billing errors
- Pull daily reports utilizing Microsoft Excel and providing correct correspondence to payer
- Research payer rules and regulations to maintain current payer knowledge
- Comply with HIPAA and other compliance requirements to protect patient confidentiality
- Manage data in internal and external databases with accuracy
- Provide high-level administrative support and assistance to the Director and Supervisor or other assigned leadership staff
- Perform clerical and administrative tasks including drafting letters, memos, invoices, reports, and other documents for senior staff
- Prepare patient charts for medical audits
- High School Diploma
- Excellent verbal and written communication skills
- Excellent organizational skills and attention to detail
- Excellent time management skills with a proven ability to meet deadlines
- Ability to function well in a high-paced and at times stressful environment
- Extensive knowledge of office administration, clerical procedures, and recordkeeping systems
- Able to type minimum of 50 words per minute
Nice To Haves
- Healthcare experience strongly preferred
- Knowledge of CMS, State Regulations, URAC and NCQA guidelines preferred.
- ICD-10 and CPT coding experience a plus
- Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system a plus
- Extremely proficient with Microsoft Office Suite or similar software with the ability to learn new or updated software
- Medical Terminology preferred
Responsibilities
- Coordinates phone calls
- Coordinates clinical requests
- Upkeeps data entry
- Organizes denials and mailing/faxing appeals
- Tracking data from various insurance providers and health plans regarding authorization and/or denials
- Expedite reviews and documentation to insurance providers
- Monitors patient charts and records to provide to responsible parties and request for authorization for hospital admission
- Reviews treatment plans and status of approvals from insurers
- Collects and compiles data as required and according to applicable policies and regulations
- Performs administrative duties for the Utilization Management Department, and directed in several aspects of duties
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
