Utilization Review Support Specialist-2
Utilization Review Support Specialist-2
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Job Description
Overview:
Job Description Summary:
Job Description:
- 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.
- Associates 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
Required Experience:
Unclear Seniority
Employment Type
Full-Time
