Utilization Management Assistant

Job Summary

To support hospital claims processing, the full-time Utilization Management Assistant will triage denied claims, conduct root cause analyses, and coordinate with clinical teams to prepare and submit appeal packets remotely.

Key responsibilities

• Receive, triage, and prioritize denied hospital claims based on various requirements
• Conduct root cause analysis to identify reasons for claim denials and coordinate with relevant teams for appeal viability
• Track denial and appeal activity while maintaining accurate documentation and identifying trends for process improvement

Required qualifications

• High school diploma
• 3-5 years of relevant experience in hospital revenue cycle, clinical denials, or medical claims processing
• Experience with inpatient hospital claims and payer portals
• Strong understanding of payer denial codes and appeal workflows
• Clinical background or experience working with nursing or utilization management teams is preferred