Utilization Management Coordinator

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

📋 Description

• Oversee the complete authorization process, beginning with initial notification, entry, and submission of necessary information, followed by follow-up, determination, and discharge.

• Ensure thorough documentation within the EMR system, the internal CorroHealth system, and Health Payer portals.

• Confirm eligibility and benefits for patients accurately.

• Serve as a communication bridge between hospital personnel and Health Payers to promote information exchange and timely process completion.

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

• Monitor and follow up with payers regarding pending authorizations to guarantee prompt responses.

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

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

• Manage a designated workload of accounts through prompt follow-up and precise record-keeping.

• Ensure compliance with HIPAA and other healthcare regulations.

⛳️ Requirements

• High School Diploma or equivalent.

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

• Two years of experience in hospital-related billing, follow-up, healthcare settings, or authorization.

• Familiarity with or experience in managed care contracts.

• Experience in customer support or client issue resolution management.

• Strong understanding of medical terminology and insurance processes.

• Experience with EMR systems; Epic experience preferred.

• Exceptional communication and organizational skills.

• Strong multitasking abilities in a fast-paced environment.

• Proficient in MS Office and web systems.

• Required schedule: Tuesday to Saturday, from 8:00 AM to 5:00 PM EST.

• Availability for some holiday coverage.

• Capability to work at a computer terminal for 6-8 hours a day.

• Occasionally able to lift and move materials weighing up to 20 lbs.

🏝️ Benefits

• Remote work available within the US ONLY.

• Equipment provided for remote work.

• Medical, Dental, and Vision Insurance.

• 401k matching (up to 2%).

• Paid Time Off: 80 hours accrued annually.

• Nine paid holidays each year.

• Life Insurance coverage.

• Options for Short and Long term disability.

• Tuition reimbursement opportunities.

• Professional growth and additional benefits!