Coordinator, Utilization Management

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the entire Authorization process, starting from the initial notification and continuing through the entry and submission of necessary information, follow-ups, determination, and discharge.

• Keep comprehensive documentation within the EMR system, the internal CorroHealth system, and Health Payer portals.

• Confirm accurate eligibility and benefits for patients.

• Serve as a liaison between hospital personnel and Health Payer to promote information sharing and ensure successful process completion within stipulated timeframes.

• Review the timely filing guidelines related to the utilization management process.

• Monitor and follow up with payers on outstanding authorizations to guarantee prompt responses.

• Reach out to payers for additional information regarding status and decisions to eliminate processing obstacles.

• Recognize and escalate issues that could lead to delays or denials.

• Manage an assigned workload of accounts through timely follow-ups and precise record-keeping.

• Adhere to HIPAA and other healthcare regulations.

⛳️ Requirements

• High School Diploma or equivalent.

• Associate degree in healthcare administration or a related field preferred.

• A minimum of 2 years’ experience in hospital billing, follow-up, healthcare settings, or the authorization field.

• Familiarity with or experience in working with managed care contracts.

• Experience in customer support or client issue resolution management.

• Strong knowledge of medical terminology and insurance processes.

• Experience using EMR systems; Epic is preferred.

• Excellent communication and organizational abilities.

• Strong multi-tasking capabilities in a fast-paced environment.

• Proficient in MS Office and web systems.

• Required working hours: 8:00 AM to 5:00 PM EST, either Sunday - Thursday or Tuesday - Saturday; availability for some holiday coverage is needed.

• This position is remote and available only within the US.

🏝️ Benefits

• Competitive hourly salary.

• Equipment provided.

• Medical, Dental, and Vision Insurance.

• 401k matching (up to 2%).

• PTO: 80 hours accrued annually.

• 9 paid holidays each year.

• Life Insurance.

• Options for Short/Long term disability.

• Tuition reimbursement.

• Opportunities for professional growth and more!