Utilization Review Coordinator

3 weeks ago

Pasig, Philippines VISAYA Full time

Role Overview We are looking for a detail-oriented Utilization Review Coordinator/Medical Management Resolution Specialist to join our team. The ideal candidate will have experience in medical coding within the US healthcare system, whether certified or non-certified, and a strong background in medical management resolution. Responsibilities Collect, verify, and input information accurately to ensure everything is in place before passing it to a nurse for clinical review. Conduct thorough reviews of disputed medical claims to determine the medical necessity of services provided to members. Collaborate with healthcare providers, coders, and payers to clarify documentation and ensure accurate coding and claim resolution. Assist in resolving denials, discrepancies, and other issues related to medical management and billing. Maintain detailed records of case resolutions and communicate updates to relevant stakeholders. Support process improvement initiatives to enhance accuracy and efficiency in medical management resolution. Ensure compliance with company policies and regulatory standards. Accurately input case details, clinical data, and communications into internal systems. Maintain records of all correspondence, decisions, and outcomes related to IDR cases. Ensure all documentation is complete and compliant with federal regulations. Facilitate communication between clinical teams and administrative staff to ensure accurate and timely submissions. Assist in drafting, editing, and updating Standard Operating Procedures (SOPs). Qualifications College level education. Minimum of 2 years related experience in medical management resolution or administrative work in utilization management. Certified Medical Coders or Non-Certified Experienced Medical Coders with US healthcare experience is an advantage. Strong understanding of medical coding systems and healthcare terminology. Excellent problem-solving, communication, and analytical skills. Willingness to work onsite in Ortigas and on a night shift schedule. Detail-oriented with the ability to manage multiple cases efficiently. Perks And Benefits 15% Night Differential HMO coverage after 30 days of employment (with option to add up to 2 dependents) Retirement Benefits 24 Leave Credits per year (convertible to cash) Wholistic Employee Wellness Program Why Join Visaya KPO? Be part of a multi-awarded, 100% Filipino-owned company recognized for its leadership and innovation in the outsourcing industry. Work in a culture that values professional growth, employee well-being, and long-term partnerships. Enjoy industry-leading benefits and a supportive, inclusive environment. Visaya KPO is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Job Type: Full-time #J-18808-Ljbffr

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