Utilization Review 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

The Utilization Review Support Specialist completes and documents in Cone Healthlink (CHL/EPIC) payor communication to include notification of beneficiary admission per payor requirements and timelines, authorization status and contact information for clinical follow-up.

Essential Job Function:

• Reviews accounts to ensure accuracy and compliance with notice of admission requirements.
• Identifies where additional non-clinical details are required and initiates action to document the needed information.
• Ensure the accurate and timely submission of all administrative documents to the relevant parties, maintaining the highest standards of administrative support.
• Ensures a detailed account history by documenting all activities conducted on accounts.
• Identifies and escalates complex or time sensitive issues to leadership or the designated utilization review team in a timely manner.
• Meets/maintains productivity and quality standards to ensure excellent service is provided to customers.
• Utilize technology as necessary to complete job requirements.
• Maintains comprehensive knowledge of payer requirements, communication preferences, and access to payer portals, as well as governmental regulations, HIPAA, and commercial payer rules.
• Organizes work/resources to accomplish objectives and meet deadlines.
• Coordinates information and findings with Revenue Cycle Services to help recognize or resolve possible payment problems.
• Performs other duties as assigned.

Education:

• Required: High School Diploma or equivalent.

Experience:

• Required: 2+ years of experience in a Patient Access, Care Management, or Utilization Review support role.