Coordinator, Utilization Management

About the Role

This is a REMOTE position within the US only, with a required schedule of Tuesday - Saturday, 8:00 AM to 5:00 PM EST, including some holiday coverage. As a Coordinator, Utilization Management, you will manage the authorization process end-to-end, act as a liaison between hospital staff and health payers, and ensure compliance with healthcare regulations.

Responsibilities

• Manage the authorization process from initial notification to discharge, including submission of required information and follow-up.
• Maintain detailed documentation in the EMR system, internal CorroHealth system, and health payer portals.
• Verify correct eligibility and benefits for patients.
• Facilitate information sharing between hospital staff and health payers to ensure timely process completion.
• Review timely filing guidelines for the utilization management process.
• Track and follow up with payers on pending authorizations.
• Contact payers to gather information, resolve issues, and expedite processing.
• Identify and escalate potential delays or denials.
• Manage assigned accounts through timely follow-up and accurate record-keeping.
• Maintain compliance with HIPAA and other healthcare regulations.

Qualifications

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

Benefits

• Remote work within the US.
• Equipment provided.
• Medical, Dental, and 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 opportunities.

Physical Demands

Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Regular eye-hand coordination and manual dexterity are required to operate office equipment. The ability to work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is necessary. Prolonged sitting, occasional lifting of up to 20 lbs, and elevated stress levels during peak periods may be experienced.