Coordinator, Utilization Management

CorroHealth, Inc.; Georgia; Remote; USD 45,000 - 65,000; Full time

Job summary

CorroHealth, Inc. is seeking a detail-oriented Authorization Specialist to manage end-to-end authorization processes across EMR and payer portals. The role requires effective communication with hospital staff and payers to ensure timely determinations and compliant documentation.

Ideal candidates have 2+ years in hospital billing/follow-up, knowledge of managed care contracts, and proficiency with EMR systems (Epic preferred) along with strong organizational and multitasking skills.

Qualifications

• High School Diploma or equivalent; associate degree preferred.
• 2 years of experience in hospital billing/follow-up/authorization.
• Knowledge of managed care contracts.
• Experience with customer support and issue resolution.
• Familiarity with medical terminology and insurance processes.
• EMR systems experience; Epic preferred.
• Excellent communication and organizational skills.
• Strong multitasking in a fast-paced environment.
• MS Office and web systems proficiency.

Responsibilities

• Manage the Authorization process end to end from notification to discharge.
• Document records in EMR, internal system, and payer portals.
• Verify eligibility and benefits for patients.
• Liaise between hospital staff and Health Payer to share information.
• Review timely filing guidelines for utilization management.
• Track and follow up with payers on authorizations.
• Contact payers to obtain status updates and resolve hurdles.
• Identify and escalate issues causing delays or denials.
• Maintain workload and records; HIPAA compliance.

Skills

Communication skills

Organization skills

Multi-tasking

MS Office

Epic EMR

Education

High School Diploma or equivalent

Associate degree in healthcare administration

Tools

Epic EMR

MS Office

Job description

About Us

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

JOB SUMMARY

ESSENTIAL DUTIES AND RESPONSIBILITIES

Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Location: Remote (Within US Only)

Required Schedule : 8:00 AM to 5:00 PM EST, Tuesday - Saturday, OR Sunday - Thursday - (cannot guarantee preferred shift and some holiday coverage required)

Job Summary

• Manage the Authorization process end to end, from initial notification, entry and submission of required information, follow up all the way to determination and discharge.
• Maintain detailed documentation of the record in the EMR system, in the internal CorroHealth system and in the Health Payer portals.
• Verify correct eligibility and benefits for patients.
• Act as a liaison between the hospital staff and the Health Payer to facilitate information sharing and successful process completion within allocated timeframe.
• Review timely filing guidelines regarding the utilization management process.
• Track and follow up with payers on pending authorizations to ensure timely responses.
• Contact payer to elicit further information regarding status, decisions and remove hurdles in the processing.
• Identify and ***escalate*** issues that may result in delays or denials.
• Manage assigned workload of accounts through timely follow up and accurate record keeping.
• Maintain compliance with HIPAA and other healthcare regulations.

Skills Required

• High School Diploma or equivalent. Associate degree in healthcare administration or equivalent preferred.
• 2 years of experience in hospital related billing/follow-up/healthcare setting/authorization field.
• Knowledge of/experience working with managed care contracts
• Experience working with customer support/client issue resolution management.
• Strong understanding of medical terminology and insurance processes.
• Experience working in EMR systems, Epic preferred.
• Excellent communication and organization skills.
• Strong multi-tasking skills, working in a face paced environment.
• Proficiency with MS Office and web systems.

What we offer

• Competitive hourly rate
• Remote within US ONLY
• Equipment provided
• Medical/Dental/Vision Insurance
• 401k matching program
• PTO: 80 hours accrued, annually
• 9 paid annual holidays
• Life Insurance
• Short/Long term disability options
• Tuition reimbursement
• Professional growth and more!

PHYSICAL DEMANDS

Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.