Utilization Management Support Specialist II

This is a fully remote position, open to applicants in California, +2 more states.

📋 Description

• Collect, process, analyze, and document payer information to validate acute hospital admissions, continued stays, and billing for the appropriate level of care.

• Manage concurrent and retrospective denials in conjunction with clinical utilization management teams and internal physician advisors.

• Create, coordinate, and oversee the appeal and denial process systems under management supervision.

• Monitor and analyze data trends.

• Collaborate with leadership and key stakeholders in utilization management operations.

• Serve as a liaison between leadership, external payers, staff, and related departments.

• Identify and troubleshoot level-of-service and payer behavior issues while tracking and analyzing trends.

• Recognize opportunities for process enhancements.

• Support assigned projects and engage in departmental meetings and team discussions.

• Comply with privacy, safety, and regulatory standards to ensure optimal patient care.

⛳️ Requirements

• High School Diploma or General Education Diploma (GED), or equivalent experience accepted in place of the required degree or diploma.

• At least 1 year of recent relevant experience.

• Familiarity with medical terminology.

• Experience in medical insurance verification and payer reimbursement plans.

• Understanding of revenue cycle processes and the criteria necessary for payment procedures.

• Proven knowledge of electronic health records and relevant computer applications.

• Strong written and verbal communication skills.

• Effective time management and organizational abilities.

• Capability to prioritize tasks and meet deadlines, production, and quality standards.

• Ability to work autonomously as well as collaboratively within a team.

• Skilled in identifying, assessing, and resolving problems using established options.

• Competence in building collaborative relationships with both internal and external customers.

• Availability to work rotating weekends.

• Compliance with local, state, and federal regulations, codes of conduct, policies, and procedures.

🏝️ Benefits

• Comprehensive benefits package for eligible positions.

• Total rewards program.

• Regular employee status.

• Full-time schedule with 40 hours per week.