Clinical Coordinator
3 weeks ago
St. Mary's Health Network, a member of Prime Healthcare, is committed to delivering exceptional patient care and advancing the healthcare industry. With a rich 114-year history, our health system offers a comprehensive range of inpatient, outpatient, and ancillary services. Our award-winning team is dedicated to upholding our core values of quality, compassion, and community.
Estimated Salary: $55,000 - $65,000 per year.
Job Description:
The Utilization Review Tech plays a vital role in coordinating the utilization review and appeals process as part of denial management initiatives. This position requires strong communication skills to track data from various insurance providers and health plans regarding authorization, expedited reviews, and appeals. The successful candidate will document and track all communication attempts with insurance providers and health plans, working closely with the Corporate/Facility Utilization Review teams, Business Office, and Case Managers.
Responsibilities:
- Coordinate phone calls and data entry for insurance providers and health plans.
- Track 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.
- Work closely with the Corporate/Facility Utilization Review teams, Business Office, and Case Managers.
Qualifications:
- Minimum one year denials management experience in an acute care setting highly preferred.
- High School Diploma or equivalent required.
- Accurate alphabetic, numeric, and/or terminal-digit filing skills.
- Computer data entry with 10-key, with accurate typing speed of 35 wpm required.
- Excel skills highly preferred.
- Knowledge of terminal digit filing and medical terminology; preferred.
- Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.
- Completion of a medical terminology course; preferred.
- Background in business and office training; preferred.
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