Utilization Review Technician

Part-time

Prime Healthcare

Gadsden, ALPart-timeNo compensation foundPosted 2w agoVerified open 5 days ago

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At a glance

Compensation

No compensation found

Location

Gadsden, AL

Schedule

Part-time

Work Authorization

Not specified

Job overview

Prime Healthcare is hiring an Utilization Review Technician. Prime Healthcare seeks a Utilization Review Technician II to support utilization review, appeals, and denial management by coordinating communication, tracking payer activity, and assisting with audits, release of information, and discharge coordination within the Social Work Services department.

Key focus areas include Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews, appeals, and denials, Document and track all communication attempts with insurance providers and health plans, and Follow up on denials while partnering with Utilization Review, Business Office, and Case Management teams.

Important skills include 10-Key Data Entry, Computer Data Entry, Typing Speed 35 Wpm, Alphabetic Filing, Numeric Filing, and Terminal-Digit Filing.

Skills & qualifications

RequiredNice to have

Skills

10-Key Data EntryComputer Data EntryTyping Speed 35 WpmAlphabetic FilingNumeric FilingTerminal-Digit FilingMedical TerminologyState and Federal Regulatory Requirements

Qualifications

High School Diploma or EquivalentTwo Years Relevant ExperienceAssociates Degree or HigherCompletion of Medical Terminology CourseBusiness and Office Training Background

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

Paid Time Off

Tuition Assistance

401(k) Match

Full job description

Overview Department: Social Work Services

Shifts Available: Days

Employment Type: Full Time

Hours: 8-hour shift – 7:30am to 3:30pm

Location: Riverview Regional Medical Center – Gadsden, AL

We are seeking an Utilization Review Technician II , sometimes referred to as Utilization Management Technician II or Utilization Review Coordinator II. The Utilization Review Technician II supports the utilization review, appeals, and denial management process by coordinating communication and tracking payer-related activity. This role works closely with insurance providers, health plans, Utilization Review teams, the Business Office, and Case Managers to help ensure timely follow-up on authorizations, reviews, appeals, and denials. The position also assists with payer audits, Release of Information, discharge coordination, and other departmental needs.

Responsibilities

Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews, appeals, and denials
Document and track all communication attempts with insurance providers and health plans
Follow up on denials while partnering with Utilization Review, Business Office, and Case Management teams
Maintain accurate tracking of government and payer audits, including RAC, MAC, CERT, ADR, QIO, Medicaid, and pre/post-payment reviews
Provide support with Release of Information, discharge coordination, and other assigned departmental duties

Qualifications

High School Diploma or equivalent
Two years of relevant experience
Accurate alphabetic, numeric, and/or terminal-digit filing skills
Computer data entry with 10-key, with accurate typing speed of 35 wpm
Associates Degree or higher, preferred
Excel skills. highly preferred
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

Here are some of the benefits of working at Prime Healthcare:

Health, dental, and vision insurance options
Paid vacation, sick time and holidays
Bereavement leave, FMLA and other leave options
Employer 401K options
Tuition reimbursement options
Life, disability, and other insurance options
Many other amazing benefits

Full benefits at Prime Healthcare: https://www.primehealthcare.com/careers/benefits/

#LI-MP1

Employment Status Full Time Shift Days Equal Employment Opportunity Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

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