About this role
The Utilization Review Support Specialist completes and documents in Cone Healthlink (CHL/EPIC) payor communication to include notification of beneficiary admission per payor requirements and timelines, authorization status and contact information for clinical follow-up.
Essential Job Function:
• Reviews accounts to ensure accuracy and compliance with notice of admission requirements. • Identifies where additional non-clinical details are required and initiates action to document the needed information. • Ensure the accurate and timely submission of all administrative documents to the relevant parties, maintaining the highest standards of administrative support. • Ensures a detailed account history by documenting all activities conducted on accounts. • Identifies and escalates complex or time sensitive issues to leadership or the designated utilization review team in a timely manner. • Meets/maintains productivity and quality standards to ensure excellent service is provided to customers. • Utilize technology as necessary to complete job requirements. • Maintains comprehensive knowledge of payer requirements, communication preferences, and access to payer portals, as well as governmental regulations, HIPAA, and commercial payer rules. • Organizes work/resources to accomplish objectives and meet deadlines. • Coordinates information and findings with Revenue Cycle Services to help recognize or resolve possible payment problems. • Performs other duties as assigned.
Education:
• Required: High School Diploma or equivalent.
Experience:
• Required: 2+ years of experience in a Patient Access, Care Management, or Utilization Review support role.
Licensure/Certification/Listing: