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Entry Level Utilization Review Jobs in Virginia (NOW HIRING)

Fairfax County

Administrative Assistant V

Fairfax, VA · On-site

$55K - $96K/yr

Coordinates "no authorization" denials in collaboration with the Utilization Management Team (UMT ... Periodically reviews position descriptions and updates them as needed, participates in the hiring ...

CDIT LLC

Junior Business Process Analyst

Norfolk, VA · On-site

$25.75 - $34.25/hr

... Support analysis of workforce utilization and operational efficiency • Help document ... process review sessions Required Qualifications Education Bachelor's degree from an accredited ...

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All JobsUtilization Review JobsEntry Level Utilization Review JobsEntry Level Utilization Review Jobs in Virginia

Entry Level Utilization Review information

What is the difference between Entry Level Utilization Review vs Medical Claims Processor?

AspectEntry Level Utilization ReviewMedical Claims Processor
Required CredentialsTypically a healthcare-related certification or degree, such as a nursing license or health administration degreeHigh school diploma or equivalent; certification may be preferred but not always required
Work EnvironmentHealthcare settings, insurance companies, or third-party review organizationsInsurance companies, healthcare providers, or billing offices
Job FocusAssessing medical necessity for treatments and services, reviewing patient recordsProcessing and reviewing insurance claims for accuracy and completeness

While both roles involve working within healthcare and insurance industries, Entry Level Utilization Review focuses on evaluating the necessity of medical services, often requiring healthcare credentials. Medical Claims Processors primarily handle insurance claims processing, with less emphasis on clinical review. Understanding these differences helps job seekers identify the right career path based on their skills and interests.

What are the most commonly searched types of Utilization Review jobs in Virginia? The most popular types of Utilization Review jobs in Virginia are:
Entry Level Utilization Review jobs near you
Infographic showing various Entry Level Utilization Review job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 17% Part Time, and 4% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Patient Access Associate Specialist - PRN

Ensemble Health Partners

Fredericksburg, VA

$17 - $18.15/hr

Per diem

Re-posted 2 days ago

Ensemble Health Partners rating

6.6

Company rating: 6.6 out of 10

Based on 244 frontline employees who took The Breakroom Quiz

141st of 150 rated financial services

Job description

ENTRY LEVEL CAREER OPPORTUNITY OFFERING:

  • Bonus Incentives

  • Paid Certifications

  • Tuition Reimbursement

  • Comprehensive Benefits

  • Career Advancement   

  • This position pays between $17.00 - $18.15 based on experience 

***This position is an onsite role, and candidates must be able to work on-site at MWHC - Mary Washington Hospital in Fredericksburg, VA**** 

We are searching for the next Patient Access Specialist champion. This role is responsible for performing admitting duties for all patients admitted for services at the hospital. They are responsible for performing these functions while meeting the mission and goals of the organization and all regulatory compliance requirements. The Representative will work within the policies and processes as they are being performed across the entire organization.

Job Responsibilities:

  • Patient Access staff are responsible for assigning accurate MRNs, completing medical necessity / compliance checks, providing proper patient instructions, collecting insurance information, receiving, and processing physician orders, and utilizing an overlay tool while providing excellent customer service as measured by Press Ganey.

  • Operates the telephone switchboard to relay incoming, outgoing, and inter-office calls as applicable.

  • They are to adhere to policies and provide excellent customer service in these interactions with the appropriate level of compassion.

  • Patient Access staff will be held accountable for point of service goals as assigned.

  • Patient Access staff are responsible for the utilization of quality auditing and reporting systems to ensure accounts are corrected. These activities may include accounts for other employees, departments, and facilities. Conducts audits of accounts and assures that all forms are completed accurate, timely to meet audit standards and provides statistical data to Patient Access leadership.

  • Patient Access Staff are responsible for the pre-registration of patient accounts prior to patient visits. This may include inbound and outbound calling to obtain demographic, insurance, and other patient information including the patient financial liabilities including collecting point of service collections as well as past due balances including payment plan options.

  • The Patient Access Staff explains general consent for treatment forms to the patient/guarantor/legal guardian, obtains necessary signatures and witness’s name. Explains and distributes patient education documents, such as Important Message from Medicare, Important Message from Tricare, Observation Forms, MOON form, Consent forms, and all forms implemented for future services.

  • Reviews eligibility responses in insurance verification system and appropriately selects the applicable insurance plan code, enters benefit data into system to support POS (Point of Service Collections) and billing processes to assist with a clean claim rate.

  • Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate. Responsible for distribution and documentation of other designated forms and pamphlets.

Experience We Love: 

  • 1+ years of customer service experience

  • Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences 

Minimum Education:

  • High School Diploma/GED Required


 

Certifications:

  • CRCR Required within 9 months of hire (Company Paid)

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