Utilization Review Tech III - Lower Bucks Hospital

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Lower Bucks Hospital, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

Lower Bucks Hospital is a community hospital, serving the Lower Bucks County region with medical, surgical, and emergency care. Located in historic Bristol, Pennsylvania, the Hospital is well-known for its knowledgeable medical staff, including cardiology, orthopedics, radiology, wound care, and general surgery. The hospital has more than 200 physicians on staff, as well as another 700 employees.

We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics.  If you need special accommodation for the application process, please contact Human Resources.  Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. The Utilization review tech will further support the department needs for Release of Information, discharge coordination or other duties as assigned.

Education and Work Experience

1. Bachelor’s degree or four years of relevant experience required.
2. Accurate alphabetic, numeric, and/or terminal-digit filing skills.
3. Computer data entry with 10-key, with accurate typing speed of 35 wpm required. Excel skills highly preferred.
4. Knowledge of terminal digit filing and medical terminology; preferred.
5. Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.
6. Completion of a medical terminology course; preferred.
7. Background in business and office training; preferred.