Support Specialist- Utilization Review (Non-Nursing)/Full Time/Remote

General Summary

The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution process. Responsible for obtaining and tracking approvals, denials, and additional information requests received from third party payers within the EMR.

Principle Duties And Responsibilities

• Acts as a subject matter expert in insurance authorization requirements, timeframes, and various revenue cycle related requirements.
• Submits all clinical information required by payers.
• Responds to payer requests, inquiries, and/or escalates issues to leadership.
• Processes, familiarizes, and completes communication forms required by payers.
• Works directly with coordinators regarding clinical issues for resolution.
• Processes all incoming communication from payers via fax, voicemail, email and mail, appropriately routes information to assigned team members.
• Update and load case information to payers as needed.
• Maintain a current knowledge of Utilization Management through interaction with staff and payor portal representatives.
• Identify process improvement strategies.
• Promotes individual professional growth and development by meeting requirements for mandatory continuing education and supports department goals which contribute to success of the organization.
• Perform other duties as requested.
  
  

Education/Experience Required

• High School Diploma/G.E.D.
• Working knowledge of computers and software systems
• Communication skills, verbal and written, and interpersonal skills necessary to effectively achieve department outcomes.
• Minimum one (1) year of experience in healthcare
• Experience working in Epic preferred
  
  

Additional Information

• Organization: Corporate Services
• Department: Central Utilization Mgt
• Shift: Day Job
• Union Code: Not Applicable