UtilizationManagementAssistant

**_Job Family_ :** Medical Assistant ** _Travel Required_ :** None ** _Clearance Required_ :** None _What You Will Do_**:** * Receive, triage, and prioritize denied hospital claims based on timely filing requirements, financial impact, and payer response deadlines. * Conduct root cause analysis to identify clinical, documentation, authorization, or payer‑related reasons for denial. * Coordinate with nurse reviewers, coding, utilization management, and revenue cycle teams to determine appeal viability. * Assemble and submit complete appeal packets, ensuring inclusion of appropriate clinical documentation and payer‑specific requirements. * Submit appeals via payer portals, secure fax, or mail, and confirm receipt to ensure timely adjudication. * Perform systematic appeal/um follow‑up at defined intervals until final claim resolution is achieved. * Track denial and appeal activity, maintaining accurate documentation within hospital and payer systems. * Identify denial trends and recurring issues and communicate findings to leadership to support process improvement initiatives. * Adhere to all hospital policies, payer guidelines, and regulatory requirements related to claims and appeals processing. _What You Will Need_**:** * Requires a high school diploma * 3-5 years of prior relevant experience in hospital revenue cycle, clinical denials, appeals, utilization management, or medical claims processing, health information management, or a related field. _What Would Be Nice To Have_**:** * Associates or Bachelors in healthcare administration, * Clinical background or experience working directly with nursing or utilization management teams. * Experience with inpatient hospital claims, DRG‑based reimbursement, and payer portals. * Strong understanding of payer denial codes, appeal workflows, and hospital billing processes. * Excellent organizational, analytical, and written communication skills. * Ability to manage multiple accounts simultaneously while meeting strict deadl