Senior Utilization Review Specialist

Prime Healthcare; Ontario (CA); On-site; USD 3,396,000 - 4,137,000; Full time

Job summary

Prime Healthcare is seeking a Utilization Review Technician to coordinate UR and appeals as part of denial management. You will liaise with UR techs, handle calls, data entry, mailing/faxing appeals, and track authorizations with insurers and health plans.

You will support government audits (RAC, MAC, CERT, ADR, QIO) and assist with Release of Information requests and coordination with Case Managers. Strong HIPAA knowledge is preferred.

Qualifications

• Bachelor’s degree or four years of relevant experience required.
• Microsoft Office proficiency required.
• Good communication skills.

Responsibilities

• Coordinate utilization review and appeals as part of denial management initiatives.
• Serve as liaison with UR techs, manage calls, data entry, mailing/faxing appeals, and track with insurance providers.
• Maintain government review audits and support UR team and remote counterparts.

Skills

Communication skills

Education

Bachelor’s degree or four years of relevant experience

Tools

Microsoft Office

Job description

Prime Healthcare is seeking a Utilization Review Technician to coordinate UR and appeals as part of denial management. You will liaise with UR techs, handle calls, data entry, mailing/faxing appeals, and track authorizations with insurers and health plans.

You will support government audits (RAC, MAC, CERT, ADR, QIO) and assist with Release of Information requests and coordination with Case Managers. Strong HIPAA knowledge is preferred.