Healthcare Utilization Analyst

3 weeks ago


Waukegan, Illinois, United States AHS Vista LLC Full time
About the Position

AHS Vista LLC is seeking a highly skilled Healthcare Utilization Analyst to join our team. As a key member of our healthcare team, you will be responsible for analyzing patient records to ensure compliance with government and insurance company reimbursement policies.

Key Responsibilities:

  • Analyze patient records to determine legitimacy of admission and treatment
  • Determine eligibility for benefits and services
  • Maintain accurate statistics and data from records
  • Develop and implement effective review processes
  • May assist in planning and holding quality assurance reviews
  • May supervise and coordinate activities of utilization review staff
  • Research clinical records and insurance regulations to determine next steps
  • Monitor day-to-day compliance with appeal decision time frames
  • Review clinical and medical records for completeness and determine administrative or clinical appeal

Salary Estimate: $80,000 - $110,000 per year

Requirements:

  • Current IL issued RN license
  • Graduate from an accredited nursing school


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