Coordinator, Utilization Management

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

Coordinator, Utilization Management About this position: Title: Coordinator, Utilization Management Location: Remote within US ONLY (equipment provided, work must be done within the US only) Required Schedule: Full-time shifts from 8:00 AM to 5:00 PM EST (Sunday - Thursday or Tuesday - Saturday) we cannot guarantee preferred shift and some holiday coverage required. Hourly Salary: $19.00 - $20.00 ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Manage the Authorization process end to end, from initial notification, entry and submission of required information, follow up all the way to determination and discharge. Maintain detailed documentation of the record in the EMR system, in the internal CorroHealth system and in the Health Payer portals. Verify correct eligibility and benefits for patients. Act as a liaison between the hospital staff and the Health Payer to facilitate information sharing and successful process completion within allocated timeframe. Review timely filing guidelines regarding the utilization management process. Track and follow up with payers on pending authorizations to ensure timely responses. Contact payer to elicit further information regarding status, decisions and remove hurdles in the processing. Identify and escalate issues that may result in delays or denials. Manage assigned workload of accounts through timely follow up and accurate record keeping. Maintain compliance with HIPAA and other healthcare regulations.