Utilization Review & Payer Support Specialist

Cone Health Medical Group; Greensboro (NC); On-site; USD 42,000 - 66,000; Full time

Job summary

Cone Health Medical Group is seeking an Utilization Review Support Specialist to manage payer communications and ensure timely, accurate documentation in Cone Healthlink (CHL/EPIC). The role requires attention to payer requirements, HIPAA compliance, and collaborative coordination with Revenue Cycle Services to resolve potential payment issues.

The position emphasizes documentation, adherence to timelines, and maintaining detailed account histories while supporting clinical follow-up and

Qualifications

• High School Diploma or equivalent is required.
• 2+ years in a Patient Access, Care Management, or Utilization Review support role.
• Knowledge of payer requirements, regulatory guidelines and HIPAA important.

Responsibilities

• Review accounts for notice of admission accuracy and compliance.
• Document payer communications and clinical follow-up details.
• Submit administrative documents timely to payers and internal teams.
• Maintain detailed account history of all activities.
• Escalate complex or time-sensitive issues to leadership.
• Meet productivity and quality standards for excellent service.
• Utilize required technology and payer portals per regulations.
• Coordinate with Revenue Cycle Services to resolve payment problems.
• Perform other duties as assigned.

Skills

Payer requirements

Documentation

HIPAA compliance

Customer service

Attention to detail

Education

High School Diploma or equivalent

Job description

Cone Health Medical Group is seeking an Utilization Review Support Specialist to manage payer communications and ensure timely, accurate documentation in Cone Healthlink (CHL/EPIC). The role requires attention to payer requirements, HIPAA compliance, and collaborative coordination with Revenue Cycle Services to resolve potential payment issues.

The position emphasizes documentation, adherence to timelines, and maintaining detailed account histories while supporting clinical follow-up and