Utilization Review Assistant

JOB TITLE: Utilization Review (UR) Assistant

DIRECT SUPERVISOR: Clinical Services Supervisor

JOB SUMMARY: The Utilization Review Assistant will support the prior authorization process to ensure timely approval of healthcare services and treatments for clients. They will assist in gathering necessary documentation, communicating with healthcare providers and insurance companies, and maintaining accurate records.

ESSENTIAL DUTIES:

• Assist in gathering and reviewing medical documentation required for prior authorization requests.
• Verify insurance coverage and eligibility for requested services or treatments.
• Ensure all documentation meets the criteria and guidelines set forth by insurance carriers.
• Communicate with healthcare providers to obtain additional information or clarification on prior authorization requests.
• Liaise with insurance companies to submit prior authorization requests and follow up on status updates.
• Enter information accurately into electronic health records (EHR) or prior authorization systems.
• Maintain detailed records of prior authorization requests, approvals, and denials.
• Generate reports and summaries related to prior authorization activities as needed.
• Ensure compliance with insurance policies, regulatory requirements, and organizational protocols related to prior authorizations.
• Assist in quality assurance activities to monitor the accuracy and efficiency of the prior authorization process.
• Provide administrative support to the Utilization Review Team.
• Attend all mandatory meetings.
• Complete all assigned training.
• Complete all duties assigned in a timely manner.
• Complete all other duties as assigned.

KNOWLEDGE, SKILLS, & ABILITIES:

• Previous experience in a healthcare setting, particularly in prior authorization, medical billing, or healthcare administration, is preferred.
• Knowledge of medical terminology and familiarity with insurance verification and authorization processes.
• Proficiency in computer skills, including data entry and use of electronic health records (EHR) or healthcare management systems.
• Excellent organizational and time management skills with the ability to prioritize tasks effectively.
• Strong interpersonal and communication skills, both verbal and written.
• Ability to work independently and collaboratively within a team environment.

REQUIRED EDUCATION:

• High school diploma or equivalent required; additional education or certification in healthcare administration or related field is a plus.

Pay based upon experience and licensure.

Job Type: Full-time

Pay: $16.00 - $25.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

People with a criminal record are encouraged to apply

Work Location: In person

Salary : $16 - $25