Utilization Review Technician

Overview

At North Vista Hospital, our dedicated team of professionals are committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, a Top-15 hospital system in the United States, North Vista Hospital is actively seeking new members to join its award-winning team!

North Vista Hospital is an accredited 177-bed state-of-the-art hospital located in North Las Vegas, Nevada. North Vista offers comprehensive healthcare services, including mental health care, emergency care, heart care, advanced surgical procedures, diagnostic imaging and help for a broad range of medical conditions.  Equipped with advanced medical technology and staffed by a team of highly skilled healthcare professionals, North Vista is committed to providing high-quality care in a friendly hospital environment. The hospital has achieved numerous quality award distinctions including Patient Safety Excellence Award, Bariatric Surgery Excellence Award, Heart Failure recognition and more. For more information, please visit www.northvistahospital.com.

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

1. High School Diploma or equivalent required.

2. Associates degree or higher preferred.

3. Two years of relevant experience required

4. Accurate alphabetic, numeric, and/or terminal-digit filing skills.

5. Computer data entry with 10-key, with accurate typing speed of 35 wpm required. Excel skills highly preferred.

6. Knowledge of terminal digit filing and medical terminology; preferred.

7. Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.

8. Completion of a medical terminology course; preferred.

9. Background in business and office training; preferred.

Employment Status

Shift

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