Support Specialist- Utilization Review (Non-Nursing)/Full Time/Remote

General Summary

The support specialist is a support role crucial to the centralized Utilization Review team for time-sensitive authorization tracking and resolution processes. They are responsible for obtaining and tracking approvals, denials, and additional information requests received from third-party payers within the EMR.

Principle Duties And Responsibilities

• Acts as a subject matter expert in insurance authorization requirements, timeframes, and various revenue cycle-related requirements.
• Sets up and tracks all clinical information required by payers.
• Responds to payer requests, inquiries, and escalates issues to leadership.
• Processes, familiarizes, and completes communication forms required by payers.
• Works directly with coordinators regarding clinical issues for resolution.
• Processes all incoming communication from payers via fax, voicemail, email, and mail, and appropriately routes information to assigned team members.
• Updates and loads case information to payers as needed.
• Maintains a current knowledge of Utilization Management through interaction with staff and payor portal representatives.
• Identifies process improvement strategies.
• Promotes individual professional growth and development by meeting requirements for mandatory continuing education and supports department goals that contribute to the organization's success.
• Performs other duties as requested.

Education/Experience Required

• A high school diploma/GED.
• Working knowledge of computers and software systems.
• Effective communication skills, both verbal and written, and interpersonal skills necessary to achieve department outcomes.
• Minimum one (1) year of experience in healthcare.
• Experience working in Epic preferred.