UtilizationReviewSupportSpecialist-2

**Overview:** Schedule: M-F (Day Shift) **Job Description Summary:** Provides administrative support to the Utilization Review Team and assists with eligibility verification, data entry, and coordination of information. **Job Description:** **Essential Functions:** * Coordinates with external healthcare providers, payors, patients, and internal teams to obtain and provide necessary account information. * Serves as a liaison for inquiries and issues regarding authorizations, denials, and utilization reviews. * Manages incoming and outgoing telephones, emails, and faxes. Monitors and completes multiple work queues. * Maintains accurate and complete documentation of admission authorizations and other utilization review information. * Reports utilization review progress to leadership and ensures compliance with contractual standards and regulations. * Participates in quality improvement initiatives to enhance utilization review processes. **Education Requirement:** * High School Diploma or equivalent, required. * Associate's Degree, preferred. **Licensure Requirement:** (not specified) **Certifications:** (not specified) **Skills:** Working knowledge of medical terminology, general medical office procedures, and HIPAA regulations. **Experience:** * One year of experience in hospital setting or medical office, required. * Experience with CPT, ICD-10 and HCPCS coding, preferred. * Two years of managed care experience including experience in a call center, preferred. **Physical Requirements:** OCCASIONALLY: Lifting / Carrying: 0-10 lbs, Lifting / Carrying: 11-20 lbs, Machinery, Pushing / Pulling: 0-25 lbs, Standing FREQUENTLY: Color vision, Flexing/extending of neck, Interpreting Data, Reaching above shoulder, Repetitive hand/arm use, Walking CONTINUOUSLY: Audible speech, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Peripheral vision, Problem solving, Seeing – Far/near, Sitting **Additional Physical Requirements