Utilization Review Coordinator

5 days 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

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