Utilization Review Specialist

Job Summary

A company is looking for a Utilization Review Intake Specialist to manage customer interactions and support pre-certification processes.

Key Responsibilities

• Manage customer interactions by answering and routing incoming phone calls regarding pre-certification processes
• Gather critical demographic and provider data for pre-certification using various communication methods and software
• Maintain comprehensive documentation and achieve performance standards for productivity and quality

Required Qualifications

• Associate degree preferred in business, management, or related field
• Prior experience in customer service and/or medical background
• Experience in medical front office, hospital patient intake, or medical claims processing
• Proficiency in Microsoft Excel, Word, and Outlook
• Knowledge of medical terminology; familiarity with ICD-10, CPT & HCPCS coding is desirable