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Decision details from the source listing
4+ years stated
Bachelor's degree or four years relevant experience
fixed
Dayshift
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What this posting tells you
The Utilization Review Technician III position at Prime Healthcare is a full-time remote role based out of Ontario, California (also remote in Canada). The role involves coordinating utilization review and appeals processes for denial management, working closely with insurance providers and internal teams. Candidates need a Bachelor's degree or four years of relevant experience, Microsoft Office proficiency, and good communication skills; medical terminology and HIPAA knowledge are preferred. The position follows a fixed day shift schedule. Compensation specifics are estimated but not explicitly provided. Benefits include PTO, 401K, medical, dental, vision, and tuition reimbursement.
Data, Healthcare admin, Legal, Operations, Patient support, Customer support
Canada, United States
PST (Pacific Standard Time)
mid-level · full_time
- Compensation is not listed
Data hiring on WFH.team
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Explore the remote job marketUtilization Review Technician III at Prime Healthcare Management Inc
Overview
Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!
Responsibilities
The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. This position will also serve as a liaison and own the coordination with other UR techs in the team while being responsible for coordinating phone calls, data entry, mailing/faxing appeals 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 and scan all related correspondence to the respective EMR/ tracking tool. 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. UR tech III will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The Utilization review tech will further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.
Qualifications
- Bachelor’s degree or four years of relevant experience required.
- Microsoft office proficiency.
- Good communication skills
Preferred qualifications
- Completion of a medical terminology course; preferred.
- Knowledge of HIPAA regulations preferred.
Pay Transparency
Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $24.65 to $30.03. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Employment Status
Full Time
Shift
Days
Equal Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Privacy Notice
Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf
Working remotely at Prime Healthcare Management Inc
Prime Healthcare Management Inc is hiring for 3 active remote roles, with remote-friendly openings, application links, and job details refreshed from the public remote job inventory.
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