Care Authorization & Review Specialist

SmartRecruiters, Inc.; El Paso (TX); On-site; USD 36,000 - 54,000; Full time

Job summary

SmartRecruiters, Inc. is seeking an Utilization Review support professional in the United States. This role involves processing authorization requests, verifying eligibility and benefits, and assigning appropriate billing codes.

The candidate will collaborate with multiple departments to ensure continuity of care and maintain HIPAA compliance. Required experience includes 1–4 years in a Utilization Review setting, hospital or healthcare clerical/billing background, and familiarity with medical

Qualifications

• 1-4 years of experience in a Utilization Review Department in a Managed Care Environment.
• Experience with Medical Terminology.
• Previous Hospital or Healthcare clerical, audit or billing experience.

Responsibilities

• Provide computer entries of authorization requests and provider inquiries by phone, mail, or fax.
• Verify member eligibility and benefits; determine provider status and appropriateness.
• Assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC).
• Respond to authorization requests for services per client timeframes.
• Collaborate with Behavioral Health and Long Term Care where needed.
• Request missing information from physicians per guidelines; liaison with Medical Director.
• Deliver excellent customer service for internal and external customers.
• Meet department quality standards and productivity targets.
• Maintain HIPAA confidentiality.

Skills

Customer Service

Computer Skills

Medical Terminology

Education

High School Diploma/GED

Job description

SmartRecruiters, Inc. is seeking an Utilization Review support professional in the United States. This role involves processing authorization requests, verifying eligibility and benefits, and assigning appropriate billing codes.

The candidate will collaborate with multiple departments to ensure continuity of care and maintain HIPAA compliance. Required experience includes 1–4 years in a Utilization Review setting, hospital or healthcare clerical/billing background, and familiarity with medical