Utilization Review Coordinator

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

📋 Description

• Assess, prioritize, and allocate cases for utilization review (UR)

• Handle telephone inquiries, provide precise information, and triage as needed

• Input demographic and UR data into claims or clinical management systems

• Ensure data integrity is maintained

• Gather required information for UR processing from both internal and external sources in accordance with policies and procedures

• Manage the distribution of incoming and outgoing correspondence, faxes, and mail

• Upload review documents into the paperless system when necessary

• Assist other departments as required

• Carry out additional tasks as assigned

• Contribute to the organization's quality programs

⛳️ Requirements

• High School diploma or GED is mandatory

• A minimum of two (2) years of administrative experience or an equivalent mix of experience and education is required

• Experience in customer service within the medical field is preferred

• Preferred experience in workers' compensation, disability, and/or liability claims processing

• Familiarity with medical and insurance terminology is essential

• Knowledge of ICD9 and CPT coding is required

• Strong oral and written communication skills, including the ability to present effectively

• Proficient in PC usage, including Microsoft Office applications

• Possess analytical and interpretative skills

• Exceptional organizational abilities

• Attention to detail is crucial

• Strong interpersonal skills

• Capability to work collaboratively in a team setting

• Ability to meet or surpass Performance Competencies

🏝️ Benefits

• Three medical plans available for selection

• Two dental plans available for selection

• Eligibility for tuition reimbursement

• 401K plan with a 50% match on contributions up to the first 6% saved

• Four weeks of PTO during the first full year

• Vision insurance

• Disability insurance

• Life insurance

• Employee assistance program

• Flexible spending or health savings account options

• Additional voluntary benefits available