Utilization Review Technician

Prime Healthcare•Gadsden, AL

3d•Onsite

About The Position

We are seeking a Utilization Review Technician II, sometimes referred to as Utilization Management Technician II or Utilization Review Coordinator II. The Utilization Review Technician II supports the utilization review, appeals, and denial management process by coordinating communication and tracking payer-related activity. This role works closely with insurance providers, health plans, Utilization Review teams, the Business Office, and Case Managers to help ensure timely follow-up on authorizations, reviews, appeals, and denials. The position also assists with payer audits, Release of Information, discharge coordination, and other departmental needs.

Requirements

High School Diploma or equivalent
Two years of relevant experience
Accurate alphabetic, numeric, and/or terminal-digit filing skills
Computer data entry with 10-key, with accurate typing speed of 35 wpm

Nice To Haves

Associates Degree or higher
Excel skills
Knowledge of terminal digit filing and medical terminology
Knowledge of State and Federal regulatory requirements for medical staff documentation
Completion of a medical terminology course
Background in business and office training

Responsibilities

Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews, appeals, and denials
Document and track all communication attempts with insurance providers and health plans
Follow up on denials while partnering with Utilization Review, Business Office, and Case Management teams
Maintain accurate tracking of government and payer audits, including RAC, MAC, CERT, ADR, QIO, Medicaid, and pre/post-payment reviews
Provide support with Release of Information, discharge coordination, and other assigned departmental duties