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Utilization Review Coordinator
BCForward is seeking for a highly talented and motivated Utilization Review Coordinator at Memphis, TN
Job Title: Utilization Review Coordinator
Location: Memphis, TN 38125
Duration: 6 Months
PRIMARY PURPOSE: To assign utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Accesses, triages and assigns cases for utilization review (UR).
Responds to telephone inquiries proving accurate information and triage as necessary.
Enters demographics and UR information into claims or clinical management system; maintains data integrity.
Obtains all necessary information required for UR processing from internal and external sources per policies and procedures.
Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary.
Supports other units as needed. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s).
QUALIFICATIONS Education & Licensing
High School diploma or GED required.
Experience Two (2) years of administrative experience or equivalent combination of experience and education required.
Customer service in medical field preferred.
Workers compensation, disability and/or liability claims processing experience preferred.
Skills & Knowledge Knowledge of medical and insurance terminology Knowledge of ICD9 and CPT coding
Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills
Strong organizational skills Detail Oriented Good interpersonal
skills Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.Requirements:
QUALIFICATIONS
Education & Licensing
High School diploma or GED required.
Experience
Two (2) years of administrative experience or equivalent combination of experience and education required. Customer service in medical field preferred. Workers compensation, disability and/or liability claims processing experience preferred.
Skills & Knowledge
Knowledge of medical and insurance terminology
Knowledge of ICD9 and CPT coding
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Detail Oriented
Good interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
Interested candidates please send resume in Word format Please reference job code 203455 when responding to this ad.
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