Coordinator, Utilization Management

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Title: Coordinator, Utilization Management

Location: Remote (Within US Only)

Required Schedule: 8:00 AM to 5:00 PM EST either Sunday - Thursday or Tuesday - Saturday - We cannot guarantee preferred shift and some holiday coverage required.

• Manage the Authorization process end to end, from initial notification, entry and submission of required information, follow up all the way to determination and discharge.
• Maintain detailed documentation of the record in the EMR system, in the internal CorroHealth system and in the Health Payer portals.
• Verify correct eligibility and benefits for patients.
• Act as a liaison between the hospital staff and the Health Payer to facilitate information sharing and successful process completion within allocated timeframe.
• Review timely filing guidelines regarding the utilization management process.
• Track and follow up with payers on pending authorizations to ensure timely responses.
• Contact payer to elicit further information regarding status, decisions and remove hurdles in the processing.
• Identify and escalate issues that may result in delays or denials.
• Manage assigned workload of accounts through timely follow up and accurate record keeping.
• Maintain compliance with HIPAA and other healthcare regulations.

• High School Diploma or equivalent. Associate degree in healthcare administration or equivalent preferred.
• 2 years of experience in hospital related billing/follow-up/healthcare setting/authorization field.
• Knowledge of/experience working with managed care contracts
• Experience working with customer support/client issue resolution management.
• Strong understanding of medical terminology and insurance processes.
• Experience working in EMR systems, Epic preferred.
• Excellent communication and organization skills.
• Strong multi-tasking skills, working in a face paced environment.
• Proficiency with MS Office and web systems.

• Competitive hourly salary
• Equipment provided
• Medical/Dental/Vision Insurance
• 401k matching (up to 2%)
• PTO: 80 hours accrued, annually
• 9 paid annual holidays
• Life Insurance
• Short/Long term disability options
• Tuition reimbursement
• Professional growth and more!

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Originally posted on Himalayas