Data Entry – Utilization Review

Overview

• Support utilization review processes by performing data entry and case management tasks in a fully remote role.
• Ensure compliance with HIPAA regulations while managing sensitive healthcare information efficiently.
• Collaborate with internal teams to address provider and member concerns effectively.
• Utilize advanced technology tools for documentation, correspondence, and case tracking.
• Contribute to enhancing operational efficiency and member satisfaction through proactive administrative support.
• Work within established service level agreements to ensure timely issue resolution.
• Adapt to flexible remote working hours while maintaining productivity and quality standards.
• Participate in team discussions to identify trends and improve processes.

Key Responsibilities & Duties

• Perform accurate and timely data entry for utilization review cases.
• Manage assigned caseloads efficiently, ensuring adherence to organizational policies.
• Investigate and resolve provider and member issues, maintaining professionalism.
• Collaborate with team members to identify and address operational challenges.
• Utilize CRM and ticket management tools for seamless case management.
• Communicate findings and resolutions clearly to stakeholders.
• Support administrative tasks related to utilization review processes.
• Ensure compliance with HIPAA and other regulatory requirements.
• Adapt to various shifts within operational hours to meet organizational needs.

Job Requirements

• High School Diploma or GED required.
• Minimum of 1 year of experience in customer support or service roles.
• Proficiency in using CRM and ticket management tools is essential.
• Experience in healthcare or software environments is preferred.
• Strong computer literacy, including familiarity with MacBook and Google applications.
• Excellent communication skills for interacting with providers and internal teams.
• Attention to detail to ensure compliance with HIPAA regulations.
• Ability to work independently and manage tasks remotely.
• Flexibility to adapt to varying shifts within operational hours.