Utilization Review Support Specialist

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.

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 / REGISTRY / LISTING :

Equal Opportunity Employer At Cone Health, we strive to create a welcoming atmosphere that celebrates a diverse and unique workforce. We believe in offering equal opportunities for employment to all applicants and employees, regardless of their race, religion, age, sex, sexual orientation, gender identity, veteran's status, ethnicity, national origin, disability, color, or any other characteristic protected by law. Our hiring and employment choices are based on each individual's qualifications, skills and performance. We believe that by embracing the diversity of our team, we can better serve our patients, communities and each other.