Utilization Review Technician III
About The Position
Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation’s leading health systems with nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. This position will also serve as a liaison and own the coordination with other UR techs in the team while being responsible for coordinating phone calls, data entry, mailing/faxing appeals 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 and scan all related correspondence to the respective EMR/ tracking tool. 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. UR tech III will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The Utilization review tech will further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.
Requirements
- Bachelor’s degree or four years of relevant experience required.
- Microsoft office proficiency.
- Good communication skills
Nice To Haves
- Completion of a medical terminology course; preferred.
- Knowledge of HIPAA regulations preferred.
Responsibilities
- Coordinate the utilization review and appeals process as part of the denial management initiatives.
- Serve as a liaison and own the coordination with other UR techs in the team.
- Responsible for coordinating phone calls, data entry, mailing/faxing appeals 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 and scan all related correspondence to the respective EMR/ tracking tool.
- 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.
- Function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable.
- Further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.
Benefits
- Prime Healthcare 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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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
