Resurrection Medical Center · 18 hours ago
Utilization Tech
Resurrection Medical Center is dedicated to providing comprehensive healthcare services, and they are seeking a Utilization Tech to coordinate the utilization review and appeals process. The role involves managing communication with insurance providers, tracking data, and supporting denial management initiatives.
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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
Qualification
Required
High School Diploma or Equivalent
Microsoft office proficiency
Good communication skills
Preferred
Completion of a medical terminology course; preferred
Knowledge of HIPAA regulations preferred
Benefits
Paid time off
A 401K retirement plan
Medical, dental, and vision coverage
Tuition reimbursement
Many more voluntary benefit options
Company
Resurrection Medical Center
Resurrection Medical Center is a hospital that offers emergency, inpatient, maternity, surgical, and medical services.
Funding
Current Stage
Growth StageCompany data provided by crunchbase