Responsible for utilization review support, patient account maintenance, and timely payer authorizations for initial and continued stay.
Works closely with payers, case managers, patient access, financial services, and clinical departments to ensure accurate account information in STAR and support third-party reimbursement.
Manages appeals for denied cases and helps resolve complex payer issues to reduce denials and support revenue cycle operations.
Reviews medical records to obtain authorization numbers, enters account notes, tracks payer requests, and participates in revenue cycle projects and system updates.
Serves as a resource for staff and assists with orientation, communication, and coordination across departments.
High school diploma, GED, or equivalent.
Three years of experience in a healthcare field.
Knowledge of Medicare and Medicaid regulations and commercial payer requirements.
Experience with utilization review, payer authorizations, appeals, and denial prevention.
Strong communication, problem-solving, and documentation skills.
Ability to support compliance with federal regulations and Medicaid certification requirements.
Location
Virginia, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
4 weeks ago