Utilization Review Asministrative Coordinator

Teamswell; Misamis Oriental; On-site; PHP 246,000 - 379,000; Full time

Job summary

Teamswell is seeking a Utilization Review Administrative Coordinator to support its Utilization Review department. The role focuses on managing admissions and authorization communications, ensuring accurate documentation, and submitting authorizations through payer portals.

You will maintain precise authorization records in OpenPM and communicate with treatment facilities, clinical teams, payers, and internal staff.

Qualifications

• Attention to detail and accuracy.
• Strong organizational and time-management skills.
• Excellent written and verbal communication.
• Strong problem-solving and critical-thinking abilities.
• Ability to learn new systems, payer requirements, and processes quickly.
• Initiative, accountability, and consistent follow-through.
• Sound judgment and the ability to escalate when needed.
• Professionalism when communicating with facilities, payers, and internal teams.

Responsibilities

• Manage the Authorization email and assign new intakes to the appropriate team member, and identify discharged, step-downs and changes in levels of care
• Identify insurance or policy changes that could affect authorization or reimbursement and communicate them to the appropriate team member.
• Recognize urgent or time-sensitive authorization matters and ensure they are appropriately addressed.
• Submit assigned CareOregon authorization requests through the payer portal.
• Accurately enter authorization information into OpenPM.
• Review information for accuracy and identify discrepancies, missing documentation, or incomplete information.
• Follow assigned items through completion and ensure appropriate documentation is maintained.
• Communicate clearly and professionally with treatment facilities, clinical teams, payers, and internal team members.
• Learn payer requirements, authorization processes, and behavioral health levels of care.
• Provide additional administrative support to the Utilization Review team as needed.

Skills

Attention to detail

Organizational skills

Written and verbal communication

Problem-solving

Fast-paced environment adaptability

Learn new systems

Tools

OpenPM

EHR systems

Payer portal

Job description

UTILIZATION REVIEW ADMINISTRATIVE COORDINATOR

Teamswell is a high-growth nearshore outsourcing company working for US companies. Our mission is to help small and medium-sized US businesses grow and become more profitable by having access to highly engaged, skilled, and experienced talent at a fair price, and to generate career opportunities for bilingual professionals in Latin America with fair compensation and professional and personal growth opportunities.

We are currently looking for a highly organized and detail-oriented Utilization Review Administrative Coordinator to support our Utilization Review department. This role is responsible for managing incoming admissions and authorization-related communications, ensuring information is accurately documented and routed, assisting with authorization submissions, and maintaining accurate authorization records within our systems.

In Teamswell every team member has an instrumental role and impact on the success of our business and our client’s success, so we seek to have highly motivated individuals who thrive in a fast-paced work environment, who are intelligent, eager to work hard, reliable, and able to communicate effectively with all levels of an organization. Our Utilization Review Administrative Coordinator will possess the skills and experience required and will also possess a positive attitude and ability to solve complex problems and work in a fast-paced and rapidly changing environment. We value people who are good communicators, quick learners, scrappy about finding creative solutions to problems, and conscious of their work quality. We expect all our team members to deliver excellence in both technical expertise as well as in their everyday relationships with their team.

CORE RESPONSIBILITIES

• Manage the Authorization email, assign new intakes to the appropriate team member, and identify discharged, step-downs and changes in levels of care
• Identify insurance or policy changes that could affect authorization or reimbursement and communicate them to the appropriate team member.
• Recognize urgent or time-sensitive authorization matters and ensure they are appropriately addressed.
• Submit assigned CareOregon authorization requests through the payer portal.
• Accurately enter authorization information into OpenPM,
• Review information for accuracy and identify discrepancies, missing documentation, or incomplete information.
• Follow assigned items through completion and ensure appropriate documentation is maintained.
• Communicate clearly and professionally with treatment facilities, clinical teams, payers, and internal team members.
• Learn payer requirements, authorization processes, and behavioral health levels of care.
• Provide additional administrative support to the Utilization Review team as needed.

Requirements

REQUIRED EXPERIENCE & QUALIFICATIONS

• Exceptional attention to detail and accuracy
• Strong organizational and time-management skills
• Excellent written and verbal communication
• Strong problem-solving and critical-thinking abilities
• Ability to learn new systems, payer requirements, and processes quickly
• Initiative, accountability, and consistent follow-through
• Strong ownership mentality, taking full responsibility for assigned tasks and deliverables.
• Sound judgment and the ability to recognize when an issue needs to be escalated
• Professionalism when communicating with facilities, payers, and internal teams

Preferred Qualifications

• Previous experience in behavioral health, healthcare administration, medical billing, insurance, utilization review, or revenue cycle management is preferred but not required
• Experience working with insurance portals, electronic health records, or practice management systems preferred but not required
• Familiarity with behavioral health levels of care such as Detox, RTC, PHP, and IOP is a plus
• CareOregon or Medicaid experience is a plus
• OpenPM experience is a plus
• Strong computer and data-entry skills