Utilization Review Specialist

Job Description

REQUIREMENTS

• Demonstrate excellent writing and word processing skills; google suite knowledge is preferred
• Maintain strong analytical skills with the ability to interpret clinical data effectively
• Exhibit excellent communication skills and interpersonal boundaries during collaboration with providers and patient interactions

RESPONSIBILITIES

• Request initial insurance authorization using a template for optimal success with out-of-network payors; manage appeals and denials, requesting P2P meetings as needed
• Communicate with patients/parents about benefits, co-insurance and co-pays, as well as denials and appeals
• Upload to chart the record of communication w/patients as to financial responsibility
• Upload to charts electronic copies of authorizations, denials or appeals from insurance
• Complete ongoing insurance reviews
• Collaborate with healthcare providers to develop discharge plan
• Comply with HIPAA regulations and ensure confidentiality is maintained throughout the review process
• Maintain accurate documentation of reviews, decisions made, and communications with healthcare providers

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