Utilization Review Coordinator

About This Role

The Utilization Review Coordinator is responsible for assigning utilization review requests, verifying and entering data into systems, and providing general support to clinical staff within a team environment.

Responsibilities

• Access, triage and assign cases for utilization review (UR)
• Respond to telephone inquiries providing accurate information and triage as necessary
• Enter demographics and UR information into claims or clinical management system; maintain data integrity
• Obtain all necessary information required for UR processing from internal and external sources per policies and procedures
• Distribute incoming and outgoing correspondence, faxes and mail; upload review documents into paperless system as necessary
• Support other units as needed

Requirements

• High School diploma or GED
• Two (2) years of administrative experience or equivalent
• Knowledge of medical and insurance terminology
• Knowledge of ICD9 and CPT coding
• Excellent oral and written communication skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Detail-oriented
• Good interpersonal skills
• Ability to work in a team environment

Qualifications

• High School diploma or GED
• Two (2) years of administrative experience or equivalent combination of experience and education

Nice to Have

• Customer service in medical field
• Workers compensation, disability and/or liability claims processing experience

Skills

* Required skills