UR Tech I Union - SFMC Utilization Review
Company: Prime Healthcare
Location: Lynwood
Posted on: October 17, 2020
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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 Education
and Work ExperienceMinimum one year denials management experience
in acute care setting highly preferred.High School Diploma or
equivalent required.Accurate alphabetic, numeric, and/or
terminal-digit filing skills.Computer data entry with 10-key, with
accurate typing speed of 35 wpm required. Excel skills highly
preferred.Knowledge of terminal digit filing and medical
terminology; preferred.Knowledge of State and Federal regulatory
requirements for medical staff documentation; preferred.Completion
of a medical terminology course; preferred.Background in business
and office training; 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
Keywords: Prime Healthcare, Lynwood , UR Tech I Union - SFMC Utilization Review, Other , Lynwood, California
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