Clinical Utilization & Reimbursement Specialist

Mary Free Bed Rehabilitation Hospital; United States; Remote; USD 55,000 - 85,000; Full time

Job summary

Mary Free Bed Rehabilitation Hospital is seeking a detail-oriented Utilization Review/Reimbursement Specialist to coordinate utilization management across preadmission, admission, continued stay, and discharge. You will handle prior authorizations, complex case reviews, and denial management to ensure appropriate inpatient access.

Responsibilities include data capture of denial outcomes, education support, and developing relationships with key payers.

Qualifications

• Degree in nursing, social work, physical therapy, occupational therapy, or equivalent degree.
• Valid driver’s license with no restrictions
• Spelling, grammar, and composition proficiency; accurate typing
• Ability to interact with professional staff
• Experience with Medical Records, Admissions, and Utilization Management applications

Responsibilities

• Coordinates utilization management reviews across preadmission, admission, continued stay and discharge.
• Performs prior authorization/recertification calls or faxes to insurers.
• Conducts complex case reviews to determine inpatient admission criteria.
• Develops denial management strategies to improve access to inpatient services.
• Maintains documentation of denial outcomes and data capture.
• Assists in department and hospital education; policy refinement.
• Writes insurance appeal letters on behalf of patients.
• Maintains payer relationships to improve access to inpatient services.
• Admission office duties as assigned.

Skills

Utilization management

Insurance authorization

Denial management

Documentation & medical records

Spelling/grammar/composition

Interpersonal communication

Education

Degree in nursing, social work, physical therapy, occupational therapy, speech therapy, or equivalent degree

Tools

Medical Records software

Job description

Mary Free Bed Rehabilitation Hospital is seeking a detail-oriented Utilization Review/Reimbursement Specialist to coordinate utilization management across preadmission, admission, continued stay, and discharge. You will handle prior authorizations, complex case reviews, and denial management to ensure appropriate inpatient access.

Responsibilities include data capture of denial outcomes, education support, and developing relationships with key payers.