Utilization Review Support Specialist-2

Overview:

Job Description Summary:

Provides administrative support to the Utilization Review Team and assists with eligibility verification, data entry, and coordination of information.

Job Description:

Essential Functions:

Coordinates with external healthcare providers, payors, patients, and internal teams to obtain and provide necessary account information.

Serves as a liaison for inquiries and issues regarding authorizations, denials, and utilization reviews.

Manages incoming and outgoing telephones, emails, and faxes. Monitors and completes multiple work queues.

Maintains accurate and complete documentation of admission authorizations and other utilization review information.

Reports utilization review progress to leadership and ensures compliance with contractual standards and regulations.

Participates in quality improvement initiatives to enhance utilization review processes.

Education Requirement:

High School Diploma or equivalent, required.

Associate's Degree, preferred.

Licensure Requirement:

(not specified)

Certifications:

(not specified)

Skills:

Working knowledge of medical terminology, general medical office procedures, and HIPAA regulations.

Experience:

One year of experience in hospital setting or medical office, required.

Experience with CPT, ICD-10 and HCPCS coding, preferred.

Two years of managed care experience including experience in a call center, preferred.

Physical Requirements:

OCCASIONALLY: Lifting / Carrying: 0-10 lbs, Lifting / Carrying: 11-20 lbs, Machinery, Pushing / Pulling: 0-25 lbs, Standing

FREQUENTLY: Color vision, Flexing/extending of neck, Interpreting Data, Reaching above shoulder, Repetitive hand/arm use, Walking

CONTINUOUSLY: Audible speech, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Peripheral vision, Problem solving, Seeing – Far/near, Sitting

Additional Physical Requirements performed but not listed above:

Talking on the phone/in person Constantly

"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"

R-16829