A Clinical Auditor or Utilization Reviewer reviews the efficiency of healthcare delivery. Individuals tend to have had experience as a registered nurse or other healthcare delivery roles before transferring into this quality review role.
Riverview Regional Medical Center - Gadsden, AL We are seeking an Utilization Review Technician II , sometimes referred to as Utilization Management Technician II or Utilization Review Coordinator II. The Utilization Review Technician II supports the utilization review, appeals, and denial management process by coordinating communication and tracking payer-related activity. This role works closely with insurance providers, health plans, Utilization Review teams, the Business Office, and Case Managers to help ensure timely follow-up on authorizations, reviews, appeals, and denials. The position also assists with payer audits, Release of Information, discharge coordination, and other departmental needs. Responsibilities Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews, appeals, and denials Document and track all communication attempts with insurance providers and health plans Follow up on denials while partnering with Utilization Review, Business Office, and Case Management teams Maintain accurate tracking of government and payer audits, including RAC, MAC, CERT, ADR, QIO, Medicaid, and pre/post-payment reviews Provide support with Release of Information, discharge coordination, and other assigned departmental duties Qualifications High School Diploma or equivalent Two years of relevant experience Accurate alphabetic, numeric, and/or terminal-digit filing skills Computer data entry with 10-key, with accurate typing speed of 35 wpm Associates Degree or higher, preferred Excel skills. highly preferred Knowledge of terminal digit filing and medical terminology, preferred Knowledge of State and Federal regulatory requirements for medical staff documentation, preferred Completion of a medical terminology course, preferred Background in business and office training, preferred Here are some of the benefits of working at
Prime Healthcare:
Health, dental, and vision insurance options Paid vacation, sick time and holidays Bereavement leave, FMLA and other leave options Employer 401K options Tuition reimbursement options Life, disability, and other insurance options Many other amazing benefits Full benefits at
Prime Healthcare:
https://www.primehealthcare.com/careers/benefits/ #LI-MP1 Employment Status Full Time Shift Days Equal Employment Opportunity Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories.
