Behavioral Health, Utilization Review Coordinator
Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.
Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!
Position Purpose: The UR Coordinator creates UR shells in CareRadius from faxes received. Duties include: creating UR shells, sending requests via email, fax, or phone for records to be added to electronic queues or sent directly to the department. Collaboration with points of contact at facilities to obtain EMR access for staff and to facilitate provision of medical records.
- Create UR shells from information obtained from incoming faxes within 4 hours of receipt
- Understand and adhere to HIPAA guidelines and regulations
- Complete UR letters/forms and fax/mail
- Compile medication information for medication reconciliation report/letter
- Upload medical records to authorizations in Care Radius
- Complete TOC letters/forms and fax/email
Education / Experience / Other Requirements
- High school diploma or equivalent GED
Years of Experience:
At least one (1) year clerical or administrative support experience
- Knowledge of medical terminology
- Basic understanding of the contents of a medical chart
- Medicare and Medicaid population, regulations and guidelines
- Knowledge of ICD 10 and CPT codes
- Proficiency in computer and technology utilization required, including, but not limited to: care management software, data-analytics software, Microsoft Office Products (Outlook, Excel, Power Point, Word, Visio)
Skills & Abilities:
- Ability to manage multiple projects and prioritize adhere to deadlines/time frames
- Complete tasks with little supervision
- Ability to manage large workload