Utilization Review Technician III
About The Position
The Utilization Review Technician III plays a crucial role in coordinating the utilization review and appeals process as part of denial management initiatives. This position serves as a liaison, coordinating with other UR technicians, and is responsible for managing phone calls, data entry, mailing/faxing appeals, and tracking data from various insurance providers and health plans. The role involves maintaining the integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits, and functioning as a Subject Matter Expert (SME) to support the UR tech team and remote counterparts. Additionally, the UR Tech III will support departmental needs for Release of Information, discharge coordination, and other assigned duties.
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.
- Knowledge of HIPAA regulations.
Responsibilities
- Coordinate the utilization review and appeals process as part of denial management initiatives.
- Serve as a liaison and coordinate with other UR techs in the team.
- Coordinate 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.
- 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 counterparts with specific processes.
- Support departmental needs for Release of Information through faxing and mailing.
- Assist with discharge coordination or other duties as assigned.
Benefits
- Paid time off
- 401K retirement plan
- Medical coverage
- Dental coverage
- Vision coverage
- Tuition reimbursement
- Many more voluntary benefit options
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
