Utilization Review Tech IIFacility

　　Suburban Community HospitalLocationUS-PA-East Norriton

　　ID2023-145191

　　CategoryBusiness Professional

　　Position TypeFull Time

　　ShiftDays

　　Job TypeNon-Exempt

　　Overview

　　At Suburban Community Hospital, our dedicated team of professionals is committed to our core values of quality, compassion, and community. Suburban Community Hospital is actively seeking new members to join its award-winning team!Suburban Community Hospital, a not-for-profit hospital, is part of Prime Healthcare's Pennsylvania Region. Prime Healthcare Pennsylvania Region includes Roxborough Memorial Hospital in Philadelphia, Lower Bucks Hospital in Bucks County, and Suburban Community Hospital in Montgomery County.Prime's hospitals in Pennsylvania are certified by The Joint Commission as Primary Stroke Centers and have won multiple awards through Healthgrades and the Get With The Guidelines Quality Achievement Awards though the American Heart Association. Our hospitals offer medical, surgical, and emergency care, which includes diagnostic radiology, lab services, behavior health, heart care, rehabilitation, family medicine, wound care, and residency programs.Through high quality medical care, educational programs, and community outreach services, our hospitals treat all members of our communities with respect and compassion. For more information about Suburban Community Hospital, please visit www.suburbanhosp.org.We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics.  If you need special accommodation for the application process, please contact Human Resources.  Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOCKnowYourRightsscreenreader10_20.pdf

　　Responsibilities

　　The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. The Utilization review tech will further support the department needs for Release of Information, discharge coordination or other duties as assigned.

　　Qualifications

　　Education and Work Experience

　　High School Diploma or equivalent required.Associates degree or higher preferred.Two years of relevant experience requiredAccurate alphabetic, numeric, and/or terminal-digit filing skills.Computer data entry with 10-key, with accurate typing speed of 35 wpm required. Excel skills highly preferred.Knowledge of terminal digit filing and medical terminology; preferred.Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.Completion of a medical terminology course; preferred.Background in business and office training; preferred.Connect With Us!

　　Not ready to apply? Connect with us for general consideration.

　　We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, sexual orientation, gender, gender identity, or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources:hr-prime@pr mehealthcare.com