Utilization Review Technician
About the position
The Utilization Review Technician is responsible for providing support for care coordination, network, referrals, and other pre- and post-service requests by receiving, reviewing, and acting on requests from service providers for medical procedures, treatments, and medications.
Responsibilities
- Receives and reviews incoming preservice requests from services providers and prioritizes workload to ensure timeliness standards and inventory reviews are maintained.
- Responds and resolves requests within scope of practice following standard communications protocols.
- Refers cases to appropriate nursing staff for further review if necessary.
- Acts as a resource to internal and external customers for non-medical aspects of utilization management review.
- Researches and provides both written and/or oral communication to internal and external customers and providers in a professional manner.
- Provides support by performing benefit analysis, data analysis, interpretation of suspensions, and entering information into multiple systems with accuracy and maintaining reference documents as appropriate.
- Completes daily claims inventory, collects, and prepares data/reports with accuracy and in a timely manner to appropriate staff members.
- Answers questions and responds to a variety of inquiries, provides information requiring working knowledge of policies and procedures, and resolves questions or problems relating to assigned area.
Requirements
- Associate's degree in health care administration, business, general studies or related field is required
- 3 years in medical office-setting, health insurance, or related experience is required
- Knowledge of health insurance and medical terminology, coding, healthcare, insurance, claims processing or related experience is preferred
- Demonstrated ability to communicate clearly and effectively in both verbal and written formats
- Foundational technical and professional knowledge with the ability to learn and apply new concepts
- Strong collaboration skills with the ability to work effectively across teams
- Sound basic decisionâmaking skills with the ability to identify appropriate next steps
- Proven ability to engage professionally and effectively with customers
- Exceptional attention to detail and a high degree of accuracy in all work
- Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards
Nice-to-haves
- Bachelor's degree is strongly preferred
- Knowledge of health insurance and medical terminology, coding, healthcare, insurance, claims processing or related experience is preferred
Benefits
- Affordable medical, dental and vision coverage accepted throughout the United States
- Employer funded Lifestyle Spending Accounts and Health Savings Accounts.
- Voluntary employee contributions to Health Savings Accounts and Flexible Spending Accounts
- Employer-paid life and disability insurance
- 401(k) retirement plan with company match and immediate vesting
- Paid holidays, paid time off (PTO), PTO donation program, and paid parental leave
- Voluntary benefits including Accident, Hospital Indemnity, Critical Illness, Term/Whole Life, Cancer Care Insurance, and more.
- Additional company perks
- Robust mental health offerings including an Employee Assistance Program, Learn to Live, meQ.
- Comprehensive learning and development opportunities and an Educational Assistance Program.
- 16 hours of paid volunteer time with a \$200 donation to a charity of your choice upon completion of all volunteer hours.
- Employee recognition, community initiative events and yearly company outings.
- Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
- Opportunities to connect through employee committees.
