Data Entry – Utilization Review

Overview

• Provide administrative support for utilization review activities in a remote setting.
• Perform data entry and case building with attention to HIPAA compliance.
• Manage documentation and correspondence efficiently using technology tools.
• Collaborate with internal teams to resolve provider and member concerns.
• Handle inbound and outbound communications with providers professionally.
• Utilize CRM and ticket management tools for effective case management.
• Work within established SLAs to resolve issues promptly.
• Adhere to compliance regulations and organizational policies.
• Contribute to enhancing member and provider satisfaction.

Key Responsibilities & Duties

• Perform accurate data entry and case building tasks.
• Manage assigned caseloads and queue work efficiently.
• Investigate and resolve provider and member issues within SLAs.
• Collaborate with colleagues to identify trends and roadblocks.
• Utilize internal tools and resources for seamless operations.
• Communicate findings and resolutions effectively with stakeholders.
• Support utilization review activities and general administrative duties.
• Ensure compliance with HIPAA and other regulations.
• Adapt to various shifts within operational hours.

Job Requirements

• High School Diploma or GED required.
• Minimum of 1 year of customer support/service experience.
• Advanced computer literacy skills, including CRM and ticket management tools.
• Experience in healthcare or SAAS environments preferred.
• Strong ability to use technology, including MacBook and Google applications.
• Excellent communication skills for provider and internal interactions.
• Attention to detail for HIPAA compliance and case management.
• Ability to work independently in a remote setting.
• Flexibility to work various shifts within operational hours.