Utilization Review Business Support Specialist

About the role

This position provides utilization review support, from initial insurance verification through authorization. Responsibilities include verifying patient benefits and authorization requirements, requesting authorizations, payer communication and follow-up, and processing incoming payer phone calls and faxes. The role works closely with utilization review nurses to ensure all patients entering the health system—via transfers, direct admissions, and the emergency department—have appropriate documentation and authorization for insurance payment.

Responsibilities

• Ensures accurate and complete documentation and information on all transfers and admissions, adhering to payer requirements and applicable timeframes for insurance verification, notice of admission, and authorization (45%).
• Collaborates with utilization review nurses to submit clinical reviews to payers promptly, securing authorization for the appropriate level of care and length of stay. Documents all payer communications in detail, including denial details and processes (35%).
• Identifies payer trends and provides feedback to leadership and relevant parties to mitigate denials and improve payer outcomes (10%).
• Communicates professionally and collaboratively with all parties to achieve optimal outcomes while maintaining patient confidentiality in accordance with HIPAA guidelines (10%).
• Performs other duties as assigned or required.

Requirements

• Minimum Bachelor's degree in a healthcare-related field or relevant experience and/or education as determined by the company in lieu of a bachelor's degree.
• 3 years of experience in a healthcare environment or related field with exposure to healthcare coding, billing, reimbursement, registration, or insurance verification.

Skills

• Proficient with Epic and Microsoft Office products.
• Strong analytical, organizational, problem-solving, and time management skills.
• Ability to work independently.
• Excellent written and verbal communication skills.
• Excellent attention to detail.

Pay

Base pay ranges from $21.97 to $34.39 per hour. Pay is determined by factors including a candidate’s qualifications, experience, expected contributions, internal peer equity, market considerations, and business needs. Geographic differentials may apply for certain locations.