Utilization Review Coordinator
Hispanic Alliance for Career Enhancement, Florida, NY, United States
Utilization Review Coordinator
Primary Purpose
To assign utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment.
Essential Functions and Responsibilities
Accesses, triages and assigns cases for utilization review (UR).
Responds to telephone inquiries, proving accurate information and triage as necessary.
Enters demographics and UR information into claims or clinical management system; maintains data integrity.
Obtains all necessary information required for UR processing from internal and external sources per policies and procedures.
Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary.
Supports other units as needed.
Additional Functions and Responsibilities
Performs other duties as assigned.
Supports the organization's quality program(s).
Qualifications
Education & Licensing
High School diploma or GED required.
Experience
Two (2) years of administrative experience or equivalent combination of experience and education required. Customer service in medical field preferred. Workers compensation, disability and/or liability claims processing experience preferred.
Skills & Knowledge
Knowledge of medical and insurance terminology
Knowledge of ICD9 and CPT coding
Excellent oral and written communication, including presentation 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
Ability to meet or exceed Performance Competencies
Work Environment
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental:
Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work‑related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
Physical:
Computer keyboarding, travel as required.
Auditory/Visual:
Hearing, vision and talking.
Compensation and Benefits
For the jurisdiction noted in this job posting only, the range of starting pay for this role is $18.00 - $19.00/hr. A comprehensive benefits package is offered including but not limited to medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
EEO Statement
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
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Primary Purpose
To assign utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment.
Essential Functions and Responsibilities
Accesses, triages and assigns cases for utilization review (UR).
Responds to telephone inquiries, proving accurate information and triage as necessary.
Enters demographics and UR information into claims or clinical management system; maintains data integrity.
Obtains all necessary information required for UR processing from internal and external sources per policies and procedures.
Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary.
Supports other units as needed.
Additional Functions and Responsibilities
Performs other duties as assigned.
Supports the organization's quality program(s).
Qualifications
Education & Licensing
High School diploma or GED required.
Experience
Two (2) years of administrative experience or equivalent combination of experience and education required. Customer service in medical field preferred. Workers compensation, disability and/or liability claims processing experience preferred.
Skills & Knowledge
Knowledge of medical and insurance terminology
Knowledge of ICD9 and CPT coding
Excellent oral and written communication, including presentation 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
Ability to meet or exceed Performance Competencies
Work Environment
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental:
Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work‑related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
Physical:
Computer keyboarding, travel as required.
Auditory/Visual:
Hearing, vision and talking.
Compensation and Benefits
For the jurisdiction noted in this job posting only, the range of starting pay for this role is $18.00 - $19.00/hr. A comprehensive benefits package is offered including but not limited to medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
EEO Statement
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
#J-18808-Ljbffr