Utilization Review Coordinator

Role Overview

• Assign utilization review requests.
• Verify and enter data in appropriate system(s).
• Provide general support to clinical staff in a team environment.
• Access, triage, and assign cases for utilization review (UR).
• Respond to telephone inquiries providing accurate information and triage as necessary.
• Enter demographics and UR information into claims or clinical management system; maintain data integrity.
• Obtain all necessary information required for UR processing from internal and external sources per policies and procedures.
• Distribute incoming and outgoing correspondence, faxes, and mail; upload review documents into paperless system as necessary.
• Support other units as needed.

Requirements

• High School diploma or GED required.
• Two (2) years of administrative experience or equivalent combination of experience and education required.
• Customer service in medical field preferred.
• Workers compensation, disability and/or liability claims processing experience preferred.
• Knowledge of medical and insurance terminology.
• Knowledge of ICD9 and CPT coding.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.
• Analytical and interpretive skills.
• Strong organizational skills.
• Detail Oriented.
• Good interpersonal skills.
• Ability to work in a team environment.
• Ability to meet or exceed Performance Competencies.

Benefits

• Three Medical and two dental plans to choose from.
• Tuition reimbursement eligible.
• 401K plan that matches 50% on every $ you put in up to the first 6% you save.
• 4 weeks PTO your first full year.