Description
About the Job
Location: Hybrid/Washington, D.C
Join our team and play a key role in supporting Utilization Management and payor operations!
We are seeking a detail-oriented healthcare professional to support our Utilization Management Team by coordinating authorizations, managing denials and appeals, and serving as a liaison between clinical UR staff, payors, and internal departments. This role is essential in ensuring accurate data tracking, timely communication with payors, and strong support of reimbursement and certification processes.
Key Responsibilities:Manage and process authorizations, denials, and appeals; coordinate with UR clinical staff and Patient Financial Services.
Serve as liaison between payors, third-party vendors, and internal teams to secure appropriate level of care approvals.
Track, analyze, and report denial and utilization management data; prepare trended reports for leadership.
Maintain Care Management databases and support performance improvement initiatives.
Proactively identify certification or denial concerns and escalate appropriately.
High School Diploma or GED required; Bachelor's degree in Business or Healthcare preferred.
1+ year of healthcare experience required; billing/coding or reporting experience preferred.
Strong proficiency in Microsoft Office and data management systems.
Excellent communication skills, attention to detail, and ability to maintain confidentiality.
If you are highly organized, analytical, and passionate about supporting quality patient care through strong payor management processes, we encourage you to apply.
This position has a hiring range of
USD $23.65 - USD $42.03 /Hr.
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