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 proving 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

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

Utilization Review Coordinator

Key skills