Utilization Review Support Specialist

Utilization Review Support Specialist

The Utilization Review Support Specialist completes and documents in Cone Healthlink (CHL/EPIC) payor communication to include notification of beneficiary admission per payor requirements and timelines, authorization status and contact information for clinical follow-up.

Essential Job Function:

• Reviews accounts to ensure accuracy and compliance with notice of admission requirements.
• Identifies where additional non-clinical details are required and initiates action to document the needed information.
• Ensures the accurate and timely submission of all administrative documents to the relevant parties, maintaining the highest standards of administrative support.
• Ensures a detailed account history by documenting all activities conducted on accounts.
• Identifies and escalates complex or time sensitive issues to leadership or the designated utilization review team in a timely manner.
• Meets/maintains productivity and quality standards to ensure excellent service is provided to customers.
• Utilizes technology as necessary to complete job requirements.
• Maintains comprehensive knowledge of payer requirements, communication preferences, and access to payer portals, as well as governmental regulations, HIPAA, and commercial payer rules.
• Organizes work/resources to accomplish objectives and meet deadlines.
• Coordinates information and findings with Revenue Cycle Services to help recognize or resolve possible payment problems.
• Performs other duties as assigned.

Education:

• Required: High School Diploma or equivalent.

Experience:

• Required: 2+ years of experience in a Patient Access, Care Management, or Utilization Review support role.