Utilization Tech I - Utilization Management

Chino Valley Medical Center•Chino, CA

1d•$21 - $30

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 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

Minimum one year denials management experience in acute care setting highly preferred.
High School Diploma or equivalent 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

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.