Utilization Review Tech in Ontario, CA at Prime Healthcare

Date Posted: 11/22/2020

Job Snapshot

Job Description

Responsibilities The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans and scan all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. The Utilization review tech will further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.

 

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Education and Work ExperienceRequired qualifications:

  1. High School Diploma or Equivalent.
  2. Microsoft office proficiency.
  3. Good communication skills
Preferred qualifications:

  1. Minimum one year denials management experience in acute care setting highly preferred.
  2. Completion of a medical terminology course; preferred.
  3. Knowledge of HIPAA regulations preferred.


We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf