Utilization Review Tech
Unleash the power of automation for your job search (Paid option) Apply Manually(Free)
I have time, I'll manually find and apply for jobs
Join an award-winning team of dedicated professional committed to our core values of quality, compassion and community! Roxborough Memorial Hospital, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.
Roxborough Memorial Hospital, established in 1890, is a 131-bed community hospital and part of Prime Healthcare's Pennsylvania Region. Prime Healthcare Pennsylvania Region includes Roxborough Memorial Hospital in Philadelphia, Lower Bucks Hospital in Bucks County, and Suburban Community Hospital in Montgomery County.
Prime's hospitals in Pennsylvania are certified by The Joint Commission as Primary Stroke Centers and have won multiple awards through Healthgrades and the Get With The Guidelines Quality Achievement Awards though the American Heart Association. Our hospitals offer medical, surgical, and emergency care, which includes diagnostic radiology, lab services, behavior health, heart care, rehabilitation, family medicine, wound care, and residency programs.
Through high quality medical care, educational programs, and community outreach services, our hospitals treat all members of our communities with respect and compassion. For more information visit www.roxboroughmemorial.com.
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 Experience
1. Minimum one year denials management experience in acute care setting highly preferred.
2. High School Diploma or equivalent required.
3. Accurate alphabetic, numeric, and/or terminal-digit filing skills.
4. Computer data entry with 10-key, with accurate typing speed of 35 wpm required. Excel skills highly preferred.
5. Knowledge of terminal digit filing and medical terminology; preferred.
6. Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.
7. Completion of a medical terminology course; preferred.
8. 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