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Utilization Coordinator

3 weeks, 2 days ago
Philippines
Part-time
Junior
Operations Specialist
Customer and Technical Support
HIPAA
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Remote Raven

Remote Raven

Remote Raven connects clients with highly qualified virtual assistants to quickly fill positions, enabling businesses to focus on core activities with no start-up fees.

Professional Services
11-50
View All Jobs 127

Description

  • Review incoming authorization requests and identify required clinical documentation for each payer and service type.
  • Submit prior authorization requests via fax and payer portals within payer-specific timelines.
  • Ensure requests are complete, accurate, and supported by appropriate clinical documentation.
  • Coordinate with clinical and medical teams to gather notes, treatment plans, physician orders, and supporting records.
  • Follow up proactively when documentation is incomplete or payer criteria are not met.
  • Maintain an accurate tracking log of submitted requests, pending decisions, and authorization statuses.
  • Monitor payer portals and fax queues for approvals, denials, and requests for additional information.
  • Coordinate peer-to-peer review scheduling and prepare supporting clinical materials for providers.
  • Track and resolve authorization delays, payer issues, and coverage disputes through follow-up and escalation.
  • Communicate status updates and resolution outcomes to clinical, billing, and operational stakeholders.

Requirements

  • Prior experience in utilization management, prior authorization, or insurance authorization in a healthcare setting.
  • Solid understanding of the insurance prior authorization process, including submission via fax and payer portals.
  • Familiarity with payer-specific authorization requirements and multiple payer portals.
  • Experience coordinating with clinical teams to gather and organize medical documentation.
  • Strong attention to detail and organizational skills.
  • Comfort managing multiple open authorization cases simultaneously.
  • Reliable and self-directed in a remote work environment.
  • Clear written and verbal communication skills.
  • Part-time availability for 20 hours per week, 12–4 pm MST.
  • 100% remote work arrangement.
  • Rate of $5–$6 per hour.
  • Experience coordinating peer-to-peer reviews (preferred).
  • Familiarity with InterQual or MCG (Milliman Care Guidelines) (preferred).
  • Background in behavioral health, specialty care, or a high-authorization-volume setting (preferred).
  • Experience using EHR systems and insurance payer portals (preferred).
  • Knowledge of HIPAA regulations and PHI handling (preferred).

Interested in this position?

Apply directly on the company website

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