Utilization Review Tech

Suburban Community Hospital, a 126-bed, acute care, teaching hospital in
East Norriton, PA, seeks a full-time, Utilization Review Tech.

The Utilization review tech essentially works
to coordinate the utilization review and appeals process as part of the denial
management initiatives.

Utilization review tech is responsible for coordinating
phone calls, data entry and tracking data from various insurance providers and
health plans regarding authorization, expedited reviews and appeals.

Document
and track all communication attempts with insurance providers and health plans.

Utilization review tech will follow up on all denials while working closely
with the Corporate/Facility Utilization review teams, Business Office and Case
Managers.

The Utilization review tech will also serve as the primary contact
and coordinate the work to maintain integrity of tracking government review
audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer
audits as assigned.

The Utilization review tech will further support the
department needs for Release of Information, discharge coordination or other
duties as assigned.

 EDUCATION, EXPERIENCE AND TRAINING:

 1. High School Diploma or Equivalent is required. Bachelor’s degree preferred.

2. Minimum one year denials management experience in acute care setting highly preferred.

3. Accurate alphabetic, numeric, and/or terminal-digit filing skills.

4. Excel skills highly preferred.

5. Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.

6. Computer data entry with 10-key, with accurate typing speed of 35 wpm; preferred.

7. Completion of a medical terminology course; preferred.

For more information contact our Regional Talent Acquisition Specialist:

Donna Wrubel

Regional Talent Acquisition Specialist

810-216-1984

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