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Utilization Review Support Specialist
5817 West Gate City Boulevard, Greensboro, NC 27407Posted 4 days ago
Full Time (40 Hours/Week)
Job Description
The Utilization Review Support Specialist completes and documents in Cone Healthlink (CHL/EPIC) payor communication to include notification of beneficiary admission per payor requirements and timelines, authorization status and contact information for clinical follow-up.
Essential Job Function:
- Reviews accounts to ensure accuracy and compliance with notice of admission requirements.
- Identifies where additional non-clinical details are required and initiates action to document the needed information.
- Ensure the accurate and timely submission of all administrative documents to the relevant parties, maintaining the highest standards of administrative support.
- Ensures a detailed account history by documenting all activities conducted on accounts.
- Identifies and escalates complex or time sensitive issues to leadership or the designated utilization review team in a timely manner.
- Meets/maintains productivity and quality standards to ensure excellent service is provided to customers.
- Utilize technology as necessary to complete job requirements.
- Maintains comprehensive knowledge of payer requirements, communication preferences, and access to payer portals, as well as governmental regulations, HIPAA, and commercial payer rules.
- Organizes work/resources to accomplish objectives and meet deadlines.
- Coordinates information and findings with Revenue Cycle Services to help recognize or resolve possible payment problems.
- Performs other duties as assigned.
Education:
- Required: High School Diploma or equivalent.
Experience:
- Required: 2+ years of experience in a Patient Access, Care Management, or Utilization Review support role.
Licensure/Certification/Listing: