Responsible for utilization review support, including assisting case managers with patient accounts, patient type, and timely payer authorizations for initial and continued stay. Communicates with payers, case managers, patient access, financial services, and clinical staff to maintain accurate account information in STAR and help ensure third-party payment. Manages appeals for denied cases and supports revenue cycle efforts to reduce denials.
Additional responsibilities include tracking payer requests, reviewing charts for retroactive authorizations, identifying payer issues and trends, supporting RAC-related activities, participating in revenue cycle projects and system upgrades, assisting with software/application issues, maintaining timekeeping records, and responding to account inquiries in a timely and courteous manner.
Education
- High school diploma, GED, or equivalent
Experience
- 3 years of experience in a healthcare field
Knowledge and Skills
- Knowledge of Medicare and Medicaid regulations
- Understanding of commercial payer requirements
- Ability to obtain authorization numbers from medical records and document account notes accurately
- Experience communicating with payers and internal clinical/revenue cycle teams
- Ability to track compliance issues, identify denial risks, and support appeals
- Strong problem-solving skills for complex payer and authorization issues
- Ability to assist with staff orientation and adapt to changing departmental needs
Location
Virginia, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
4 weeks ago