Utilization Review Technician - Healthcare Admin & Denials

Kpc Global Medical Centers Inc.; Santa Ana (CA); Presencial; USD 34.000 - 51.000; Jornada completa

Descripción de la vacante

Kpc Global Medical Centers Inc. in Santa Ana, CA is seeking a Utilization Review Technician to support the Utilization Management Department. Under direction, you will coordinate calls, handle clinical requests, perform data entry, and manage denials and appeals with insurers.

The role requires reviewing treatment plans, obtaining authorizations, tracking payer communications, and preparing reports. Strong organization, communication, and HIPAA compliance are essential; healthcare experience is

Formación

• High School Diploma required.
• Experience in medical billing or utilization management is a plus.
• Familiarity with CMS, state regulations, URAC and NCQA guidelines preferred.

Responsabilidades

• Coordinate phone calls, clinical requests, data entry, denials and appeals with insurers.
• Track data from insurance providers regarding authorization/denials and expedite reviews.
• Monitor and prepare patient charts and documentation for audits and approvals.
• Assist with administrative duties for the Utilization Management Department.

Conocimientos

Communication skills

Organization

Time management

Attention to detail

Typing 50 wpm

Microsoft Excel

HIPAA compliance

ICD-10/CPT coding knowledge

Microsoft Word

Microsoft Outlook

Health plan documentation systems

Educación

High School Diploma

Healthcare experience preferred

Herramientas

Microsoft Word

Microsoft Excel

Microsoft Outlook

Health plan documentation system

Descripción del empleo

Kpc Global Medical Centers Inc. in Santa Ana, CA is seeking a Utilization Review Technician to support the Utilization Management Department. Under direction, you will coordinate calls, handle clinical requests, perform data entry, and manage denials and appeals with insurers.

The role requires reviewing treatment plans, obtaining authorizations, tracking payer communications, and preparing reports. Strong organization, communication, and HIPAA compliance are essential; healthcare experience is