Utilization Review Follow-Up Specialist

Job Title: Utilization Review Follow Up Specialist

Reports to: Utilization Review Follow-Up Supervisor

Employment Status: Full-Time

FLSA Status: Non-Exempt

Job Summary:

We are seeking a diligent and detail-oriented Utilization Review Follow-Up Specialist to join our dynamic healthcare team. The ideal candidate will have experience in managing and following up on utilization reviews, prior authorizations, healthcare claims, and appeals. Experience as a Level 1 Care Coordinator is a significant plus. This role requires a professional who can effectively liaise between providers, patients, and insurance companies, ensuring timely responses and resolutions.

Duties/Responsibilities:

• Monitors and manages pending utilization review and prior authorization requests, ensuring timely submission and follow-up.
• Collaborates closely with healthcare providers to gather necessary information and/or documentation required for reviews or appeals.
• Tracks and documents the status of requests, denials, and appeals in the company's database or system.
• Communicates with insurance companies to obtain status updates, resolve issues, and expedite approvals.
• Follows up on outstanding healthcare claims, ensuring accurate processing and payment.
• Acts as the liaison with patients to inform them of the status of their requests, potential coverage issues, or any additional information required.
• Assists in the appeals process by gathering required documentation, submitting appeals, and tracking outcomes.
• Leverages experience as a Level 1 Care Coordinator to provide insights and improve the utilization review process, as needed.
• Attends training sessions, workshops, and meetings to stay updated on industry standards and best practices.
• Collaborates with internal teams, including billing, clinical staff, and management to ensure seamless patient care and service delivery.
• All other duties as assigned.

Required Skills/Abilities:

• Proficiency in healthcare management systems and Microsoft Office Suite.
• Strong organizational and multitasking skills.
• Excellent verbal and written communication abilities.
• Ability to navigate and resolve complex issues in a fast-paced environment.

Benefits

·         Health Insurance

·         Vision Insurance

·         Dental Insurance

·         401(k) plan with matching contributions