Utilization Tech I in Ontario, CA at Prime Healthcare

Date Posted: 8/3/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    3300 East Guasti Road
    Ontario, CA
  • Job Type:
  • Experience:
    At least 1 year(s)
  • Date Posted:
    8/3/2019

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 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. 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, discharge coordination or other duties as assigned.

Qualifications

Required qualifications

  • High School Diploma or Equivalent.

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    Preferred qualifications:

     

  • Minimum one year denials management experience in acute care setting highly preferred.

  • Bachelor’s degree preferred.

  • Accurate alphabetic, numeric, and/or terminal-digit filing skills.

  • Excel skills highly preferred.

  • Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.

  • Computer data entry with 10-key, with accurate typing speed of 35 wpm; preferred.

  • Completion of a medical terminology course; preferred.

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    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: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf