Utilization Review Tech

Utilization Review TechnicianUnder direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being responsible for coordinating phone calls, clinical requests, upkeeps data entry, organizes denials and mailing/faxing appeals, tracking data from various insurance providers and health plans regarding authorization and/or denials, expedite reviews and documentation to insurance providers. Monitors patient charts and records to provide to responsible parties and request for authorization for hospital admission. Reviews treatment plans and status of approvals from insurers.

Collects and compiles data as required and according to applicable policies and regulations. Performs administrative duties for the Utilization Management Department, and directed in several aspects of duties. Position is non-RN/LVN.RequirementsAbility to establish and maintain effective working relationships across the Health SystemAbility to interpret and understand various medical insurance plans and make accurate determinations regarding coverageFollow up with insurance companies regarding the status of outstanding claims and necessary steps for resolutionAnswer and review pertinent insurance correspondence to ensure complete and accurate reimbursement for medical claimsResponsible for working payer correspondence, edits and aged account receivable, and identifying and correcting billing errorsPull daily reports utilizing Microsoft Excel and providing correct correspondence to payerResearch payer rules and regulations to maintain current payer knowledgeComply with HIPAA and other compliance requirements to protect patient confidentialityManage data in internal and external databases with accuracyProvide high-level administrative support and assistance to the Director and Supervisor or other assigned leadership staffPerform clerical and administrative tasks including drafting letters, memos, invoices, reports, and other documents for senior staffPrepare patient charts for medical auditsEducation & Experience Requirements:High School DiplomaHealthcare experience strongly preferredSkills & Abilities Requirements:Excellent verbal and written communication skillsExcellent organizational skills and attention to detailExcellent time management skills with a proven ability to meet deadlinesAbility to function well in a high-paced and at times stressful environmentExtensive knowledge of office administration, clerical procedures, and recordkeeping systemsAble to type minimum of 50 words per minuteKnowledge of CMS, State Regulations, URAC and NCQA guidelines preferred.ICD-10 and CPT coding experience a plusExperienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system a plusExtremely proficient with Microsoft Office Suite or similar software with the ability to learn new or updated softwareMedical Terminology preferredPhysical Requirements:Body Positions: Sitting and standing for prolonged periods.Body Movements: Arm and hand dexterity.Body Senses: Must have command of close and distant sight, color perception and hearing.Strength: Ability to lift and move up to 25-pounds.Working Environment:Work in an office, where the climate is controlled.OSHA exposure category: IICategory I - Position includes tasks that involve exposure to Blood borne Pathogens.Category II - Position includes tasks that do not have exposure to Bloodborne Pathogens, however employment may require unplanned Category I tasks.Category III - Positions includes tasks that do not involve exposure to Bloodborne Pathogens.

This position would not be required to perform Category I tasks.