Utilization Intake Review Coordinator - Remote

About the Role

We are seeking a dedicated and detail-oriented Utilization Intake Review Coordinator - Remote to join our dynamic healthcare team. In this role, you will play a crucial part in ensuring that our utilization management processes are efficient and effective. As a Utilization Intake Review Coordinator - Remote, you will be responsible for reviewing and processing utilization requests, ensuring compliance with medical necessity criteria, and facilitating communication between healthcare providers and insurance companies.

What You'll Do

• Review and assess utilization requests for medical services to ensure they meet established criteria.
• Communicate effectively with healthcare providers to gather necessary information and clarify any discrepancies.
• Utilize your knowledge of ICD 10 and CPT codes to accurately process claims and ensure compliance.
• Maintain detailed records of all interactions and decisions made during the review process.
• Collaborate with the clinical team to address any complex cases requiring additional input.
• Participate in quality assurance audits to ensure adherence to company policies and regulatory standards.
• Assist in the development and implementation of utilization management policies and procedures.
• Provide training and support to new team members as needed.

Requirements

• Minimum of 2-5 years of experience in utilization management or a related field.
• Strong understanding of medical terminology, ICD 10, and CPT coding.
• Excellent communication and organizational skills.
• Proficiency in using healthcare management software and Microsoft Office Suite.
• Ability to analyze data and make informed decisions based on clinical guidelines.
• Experience in a remote work environment is preferred.
• Certification in utilization management or related credentials is a plus.

Nice to Have

• Experience with behavioral health and substance abuse treatment.
• Knowledge of health insurance policies and procedures.
• Previous experience in a call center or customer service role.

What We Offer

• Comprehensive medical, dental, and vision insurance.
• Employer HSA contributions covering 50% of the HDHP plan’s annual deductible.
• Company provided Basic Life and AD&D insurance.
• Company paid Short-Term and Long-Term Disability insurance.
• Flexible Spending Accounts.
• 401(k) Retirement Plan with up to a 6% employer-match.
• 10+ paid holidays and generous paid vacation and sick time.
• Annual Volunteer Paid Day, Tuition Reimbursement, and Health and Wellness Reimbursement.
• Fun company events to foster team spirit.