Strategic Utilization Management Specialist

Seven Counties; Louisville (KY); Remote; USD 42,000 - 56,000; Full time

Job summary

Seven Counties in Louisville, KY is seeking an Administrative Authorization Specialist. The role focuses on verifying benefits, obtaining preliminary and follow-up authorizations, and ensuring accurate plan information for commercial and Medicare Advantage plans.

You will move authorizations through intake to discharge, communicate needs to operations, and support retro reviews and billing updates. The position requires strong communication and attention to managed care concepts.

Qualifications

• High School diploma required; Associate degree preferred.
• Two years of administrative experience required.
• Knowledge of managed care and reimbursement concepts.

Responsibilities

• Verifies client benefits and obtains initial and subsequent authorizations.
• Verifies commercial and Medicare Advantage plans at intake and reports changes.
• Moves authorizations through the life cycle from intake to discharge.
• Communicates guarantor needs to operations staff.
• Pulls information from charts for retro reviews and appeals.
• Collaborates with operations staff on authorization processes.
• Implements tracking to obtain future authorizations and maintenance.
• Resolves billing problems and handles insurance updates.

Skills

Observation skills

Analytical thinking

Problem-solving

Communication skills

Education

High School diploma

Associate degree preferred

Tools

CPT codes

HCPCS codes

Revenue codes

Job description

Seven Counties in Louisville, KY is seeking an Administrative Authorization Specialist. The role focuses on verifying benefits, obtaining preliminary and follow-up authorizations, and ensuring accurate plan information for commercial and Medicare Advantage plans.

You will move authorizations through intake to discharge, communicate needs to operations, and support retro reviews and billing updates. The position requires strong communication and attention to managed care concepts.