Utilization Review Follow-Up Specialist (Van Nuys) - Codemax Medical Billing

Job Title: Utilization Review Follow Up Specialist

Reports to: Utilization Review Follow-Up Supervisor

Employment Status: Full-Time

FLSA Status: Non-Exempt

Job Summary:

We are seeking a diligent and detail-oriented Utilization Review Follow-Up Specialist to join our dynamic healthcare team. The ideal candidate will have experience in managing and following up on utilization reviews, prior authorizations, healthcare claims, and appeals. Experience as a Level 1 Care Coordinator is a significant plus. This role requires a professional who can effectively liaise between providers, patients, and insurance companies, ensuring timely responses and resolutions.

Duties/Responsibilities:

·       Monitors and manages pending utilization review and prior authorization requests, ensuring timely submission and follow-up.

·       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 fast-paced environment.

Benefits

·         Health Insurance

·         Vision Insurance

·         Dental Insurance

·         401(k) plan with matching contributions