Utilization Review Clerk at Lifepoint Health

Avondale, Arizona, United States -

Full Time

Start Date

Immediate

Expiry Date

26 Jun, 26

Salary

0.0

Posted On

28 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Prior Authorizations, Insurance Verification, Medical Terminology, EHR Management, Meditech, OnBase, Microsoft Office, Excel, Outlook, Insurance Portals, Availity, AZ Complete, Optum Star, Case Management, Denial Resolution, High Volume Case Management

Industry

Hospitals and Health Care

Description

Your experience matters Copper Springs is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Utilization Review Clerk joining our team, you’re embracing a vital mission dedicated to making communities healthier ®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve. How you'll contribute A Utilization Review Clerk who excels in this role: * Obtains prior authorizations and ensures all medical services, procedures, and medications meet insurance requirements prior to delivery. * Serves as a key liaison between Clinical Intake and UR Specialists to help prevent coverage gaps. Core Responsibilities Complete Precerts for IP & OP/Secure Authorizations: Initiate and secure pre-authorizations for inpatient and outpatient services through insurance portals, phone, or fax. Insurance Verification: Confirm patient eligibility, benefits, and coverage limits with the business office before precerting. Communicate all updates or status changes directly to the UR Specialist and document that information in the EHR. Documentation & EHR Management: * Update Meditech with approval numbers, status updates, and denied dates of service. * Upload and attach authorization approvals or denials to OnBase MR & scan completed packets to UR the Share drive. * Complete prior authorization request documentation for major payers, including * Banner, Health Choice, Molina, Allwell, Wellcare, and Cigna. Record Keeping: * Maintain detailed insurance logs and ensure all patient chart documentation in Meditech remains current. Departmental Support: * The UR Manager may assign other UR related task to be completed as needed. What we’re looking for Education: * High school diploma required. Two years of experience in a behavioral health setting may substitute for an associate or bachelor’s degree. An associate or bachelor’s degree in a health-related field is preferred. Experience: * Background in a medical setting with experience in insurance coordination, verification, medical terminology, case manager, discharge coordinator or behavioral health setting. Technical Skills: * Proficiency with EMR systems (Meditech or Medik), Microsoft Office applications (Excel, Outlook), and insurance portals such as Availity, AZ Complete, and Optum Star. Abilities: * Ability to manage high-volume cases, in a high stress environment by completing time sensitive requests and effectively resolve authorization denials. Schedule: Monday – Friday Why join us We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers: * Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees. * Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off. * Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match. * Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs). * Professional Development: Ongoing learning and career advancement opportunities. More about Copper Springs Copper Springs is a behavioral health hospital located in Avondale, AZ, part of the greater Phoenix metro area. We provide inpatient and outpatient programming for those facing mental health and addiction challenges. Our programs offer caring, compassionate treatment for adolescents and adults, as well as specialized programming for active-duty military, veterans, first responders, and other high-risk frontline professionals. Programs include inpatient mental health and addiction treatment, Partial Hospitalization Programs (PHP), Intensive Outpatient Programs (IOP), and Help for Heroes®. EEOC Statement Copper Springs is an Equal Opportunity Employer. Copper Springs is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment. Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country. We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.

Responsibilities

The Utilization Review Clerk obtains prior authorizations for medical services, procedures, and medications to ensure they meet insurance requirements before delivery, while also serving as a liaison between Clinical Intake and UR Specialists to prevent coverage gaps. Core duties involve initiating precerts via portals/phone/fax, verifying eligibility and benefits, updating Meditech and OnBase with authorization statuses, and maintaining detailed insurance logs.