Utilization Review Data Entry

Overview

• Support healthcare providers and members by resolving complex issues efficiently and ensuring satisfaction.
• Perform data entry and case building tasks with a focus on HIPAA compliance.
• Handle inbound and outbound communications, managing assigned caseloads effectively.
• Collaborate with internal teams to identify trends and resolve roadblocks.
• Utilize CRM and ticket management tools for efficient case resolution.
• Adhere to all applicable laws and regulations while performing duties.
• Provide world-class service to enhance member and provider satisfaction.
• Participate in training and adapt to flexible shifts between 8 AM and 8 PM ET.

Key Responsibilities & Duties

• Handle inbound and outbound provider calls and email communications efficiently.
• Manage queue work and assigned caseloads through effective dashboard utilization.
• Investigate and resolve issues within established service level agreements (SLAs).
• Collaborate with colleagues and leads to identify trends and roadblocks.
• Utilize internal tools and resources to streamline workflows and resolutions.
• Ensure compliance with HIPAA regulations and other applicable laws.
• Support utilization review activities and maintain accurate documentation.
• Perform general administrative duties as assigned by management.

Job Requirements

• High School Diploma or GED required; advanced computer literacy preferred.
• Minimum of 1 year of customer service or support experience.
• Experience with CRM, ticket management, and reporting tools is preferred.
• Proficiency in managing caseloads and documentation accurately.
• Healthcare or SaaS experience is advantageous.
• Ability to work remotely using MacBook and Google applications.
• Flexibility to work shifts between 8 AM and 8 PM ET, including weekends.
• Strong attention to detail and commitment to HIPAA compliance.