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Utilization Review Representative

Sacramento, CA | Temp-to-Hire Position

Post Date: 07/02/2018 Job ID: 39663.1 Industry: Healthcare/Medical
We are recruiting for a Utilization Review Representative for a healthcare organization in Sacramento. This role isresponsible for prescreening Treatment Plan forms, verifying benefits, data entry of authorization information, andgenerating provider and member authorization letters. Position is Monday-Friday and a contract to hire opportunity.

Responsibilities: Pre-screens Treatment Plan forms and ensures all necessary administrative data elements are present prior to entering the data into systems. Suspends or denies authorization requests for administrative reasons related to non-clinical data or benefits according to company policies. Verifies member benefit accumulators and ensures the benefit balance does not exceed 80% of the yearly benefit balance or is not exhausted. Verifies provider participation status and the members benefit to ensure HMO and POS benefits are applied correctly based on the treating provider's participation. Verifies benefit exceptions. Processes eligibility returns, return mail and date extensions. Meets and maintains department production goals and quality standards on a daily basis. Identifies problems and submits recommendations to management to correct or resolve departmental deficiencies. Completes special projects as assigned by the Utilization Review Manager and Supervisor.Assists in testing and revising department procedures.

Requirements: 1 year of data entry, medical office or related experience. High School Diploma or equivalent. Familiar with medical diagnosis coding and insurance forms. Able to work in a fast-paced, production-oriented environment. Ability to multi-task and perform a variety of job duties while maintaining quality and production standards. Type 40+ wpm. Highly accurate data entry skills. Proficient with MS Office. Excellent motivation and organizational skills. Ability to use good judgement and clear a background check.

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