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Contractual Insurance Utilization Review Jobs in Alabama

Carastar Health

Consumer Benefits Specialist

Montgomery, AL · On-site

$16.25 - $24.73/hr

Coordinate prior authorization requests, continued stay reviews, and other payer-required utilization activities. Communicate with Medicaid, Medicare, managed care organizations, commercial insurers ...

Carastar Health

Consumer Benefits Specialist

Montgomery, AL · On-site

$16.25 - $24.73/hr

Coordinate prior authorization requests, continued stay reviews, and other payer-required utilization activities. Communicate with Medicaid, Medicare, managed care organizations, commercial insurers ...

Birmingham

Quality Review Coordinator

Birmingham, AL · On-site

... private business and government utilization review, medical review, cost containment ... the health insurance program administered by this corporation. The incumbent must be able to ...

Birmingham

Quality Review Coordinator

Birmingham, AL · On-site

... private business and government utilization review, medical review, cost containment ... the health insurance program administered by this corporation. The incumbent must be able to ...

Birmingham

Care Coordinator

Birmingham, AL · On-site

$18 - $24.25/hr

Utilization review activities may include prospective, concurrent, retrospective and appeals ... The plan of care calls for contractual arrangements to be set up with providers, patient and family.

Birmingham

Care Coordinator

Birmingham, AL · On-site

$18 - $24.25/hr

Utilization review activities may include prospective, concurrent, retrospective and appeals ... The plan of care calls for contractual arrangements to be set up with providers, patient and family.

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Contractual Insurance Utilization Review information

What is the difference between Contractual Insurance Utilization Review vs Insurance Claims Adjuster?

AspectContractual Insurance Utilization ReviewInsurance Claims Adjuster
CredentialsCertifications in healthcare or insurance review, such as URAC or AAPCAdjuster licenses, certifications like AIC or CPCU
Work EnvironmentHealthcare facilities, insurance companies, or third-party review organizationsInsurance companies, claims offices, or independent agencies
Primary FocusAssessing medical necessity and appropriateness of servicesEvaluating insurance claims for coverage and settlement
Industry UsageCommon in health insurance and managed careCommon in property, casualty, and health insurance claims

Contractual Insurance Utilization Review focuses on evaluating medical necessity, while Insurance Claims Adjusters handle claims processing and settlement. Both roles require industry-specific certifications and are integral to insurance operations, but they serve different functions within the insurance process.

What cities in Alabama are hiring for Contractual Insurance Utilization Review jobs?

Cities in Alabama with the most Contractual Insurance Utilization Review job openings:

Contractual Insurance Utilization Review jobs near you

Utilization Review Technician

Gadsden, AL • On-site

Riverview Regional Medical Center
See more jobs at Riverview Regional Medical Centerexternal

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 21 hours ago

Job description

Overview
Department: Social Work Services
Shifts Available: Days
Employment Type: Full Time
Hours: 8-hour shift - 7:30am to 3:30pm
Location: Riverview Regional Medical Center - Gadsden, AL
We are seeking an Utilization Review Technician II, sometimes referred to as Utilization Management Technician II or Utilization Review Coordinator II. The Utilization Review Technician II supports the utilization review, appeals, and denial management process by coordinating communication and tracking payer-related activity. This role works closely with insurance providers, health plans, Utilization Review teams, the Business Office, and Case Managers to help ensure timely follow-up on authorizations, reviews, appeals, and denials. The position also assists with payer audits, Release of Information, discharge coordination, and other departmental needs.
Responsibilities
  • Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews, appeals, and denials
  • Document and track all communication attempts with insurance providers and health plans
  • Follow up on denials while partnering with Utilization Review, Business Office, and Case Management teams
  • Maintain accurate tracking of government and payer audits, including RAC, MAC, CERT, ADR, QIO, Medicaid, and pre/post-payment reviews
  • Provide support with Release of Information, discharge coordination, and other assigned departmental duties
Qualifications
  • High School Diploma or equivalent
  • Two years of relevant experience
  • Accurate alphabetic, numeric, and/or terminal-digit filing skills
  • Computer data entry with 10-key, with accurate typing speed of 35 wpm
  • Associates Degree or higher, preferred
  • Excel skills. highly preferred
  • Knowledge of terminal digit filing and medical terminology, preferred
  • Knowledge of State and Federal regulatory requirements for medical staff documentation, preferred
  • Completion of a medical terminology course, preferred
  • Background in business and office training, preferred
Here are some of the benefits of working at Prime Healthcare:
  • Health, dental, and vision insurance options
  • Paid vacation, sick time and holidays
  • Bereavement leave, FMLA and other leave options
  • Employer 401K options
  • Tuition reimbursement options
  • Life, disability, and other insurance options
  • Many other amazing benefits

Full benefits at Prime Healthcare: https://www.primehealthcare.com/careers/benefits/
#LI-MP1
Employment Status
Full Time
Shift
Days
Equal Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

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