Utilization Review Support Specialist

What We Offer:

• Comprehensive benefits include medical, dental, vision, and life insurance.
• Retirement fund with matching contributions.
• Tuition assistance for qualifying team members.
• Employee assistance programs and discounts. 
• Hybrid work opportunity.

What We're Looking For:

Required:

• Education: High School Diploma or GED.
• Experience: Minimum of one year of clerical and healthcare experience.
• Additional Skills (required): Excellent interpersonal and customer service skills. Working knowledge of personal computers and software including specific knowledge of Microsoft office products. Perform clerical duties with accuracy. Proficient spelling and grammatical skills. Attention to detail with excellent planning and organizational skills. Communicate effectively in both oral and written forms. Keyboard/type accurately. Ability to operate standard office equipment including, but not limited to, a calculator, fax machine, copier, printer and scanner. Establish and maintain effective work relationships. Ability to successfully complete generic and department specific skills validation and competency testing.

Preferred:

• Knowledge of Microsoft Office products with proficiency in Excel and Word.
• Revenue cycle experience working with different payer types and working knowledge of their requirements.

 

What You'll Do:

• Schedule: Monday – Friday, daytime hours, rotating holidays.
• Provide administrative and technical support to the Utilization Review team to ensure timely payer communication, authorization tracking, and accurate documentation.
• Manage daily operations of the onsite Utilization Review (UR) office, including processing mail, answering phone inquiries, making calls to verify authorizations and denial determinations, and faxing communications for multiple facilities.
• Process denials within a strict timeframe and manage payor work queues to avoid adverse determinations.
• Facilitate EMR access by sending census reports to payors.
• Process large volumes of confidential patient and payer information to support billing workflows (includes managing payor communications, processing authorizations, addressing denials, and indexing faxes).
• Establish and maintain effective work relationships with both internal and external customers.
• Maintain compliance and regulatory standards and organizational policies.