Utilization Review Technician II
About The Position
Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Paradise Valley Hospital, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference. Paradise Valley Hospital is the South Bay’s oldest hospital, the second oldest hospital in all of San Diego County, and the largest employer in National City. For more than 100 years, Paradise Valley Hospital has served San Diego faithfully, proud of our heritage and providing numerous programs and services to meet the changing needs of our community. Our 291-bed, acute care hospital featuresthe San Diego Spine & Joint Center, a highly credentialed acute rehabilitation center, our Paradise Health & Senior Center, a fully equipped and modern cardiac catheterization lab, and comprehensive inpatient and outpatient surgical services, and 24-hour emergency services. In addition to our healthcare services, we offer comprehensive behavioral health services on the hospital campus and Bayview campus in Chula Vista. Services include psychiatric continuum of care for adult patients, inpatient services, and intensive outpatient services. Learn more at https://www.paradisevalleyhospital.net/. 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
- High School Diploma or equivalent required.
- Two years of relevant experience 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
- Associates degree or higher preferred.
- 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
- Paradise Valley Hospital 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.
- A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $XX.00 to $XX.00.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
