Utilization Review - Los Angeles, United States - Codemax Medical Billing

Codemax Medical Billing

Verified Company

Los Angeles, United States

1 week ago

Posted by:

Mark Lane

beBee recruiter

Description

Job Title:
Utilization Review Follow Up Specialist

Reports to:
Utilization Review Follow-Up Supervisor

Employment Status:
Full-Time

FLSA Status:
Non-Exempt

Job Summary:_
Duties/Responsibilities:_
Monitors and manages pending utilization review and prior authorization requests, ensuring timely submission and followup.
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 fastpaced environment.