Utilization Tech I
About The Position
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, 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. 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
- High School Diploma or Equivalent.
- 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.
- 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 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.
- Support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.
Benefits
- paid time off
- a 401K retirement plan
- medical, dental, and vision coverage
- tuition reimbursement
- many more voluntary benefit options
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
