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Remote Insurance Utilization Review information

What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?

AspectRemote Insurance Utilization ReviewRemote Claims Reviewer
CredentialsTypically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H
Work EnvironmentRemote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of servicesRemote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance
Industry UsageCommonly used in healthcare insurance to evaluate medical necessityUsed across insurance sectors to process and validate claims

Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.

How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?

Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.

What are remote insurance utilization review jobs?

Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.

What are the key skills and qualifications needed to thrive as a Remote Insurance Utilization Review Specialist, and why are they important?

To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.
What are popular job titles related to Remote Insurance Utilization Review jobs in Kentucky? For Remote Insurance Utilization Review jobs in Kentucky, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Kentucky look for? The top searched job categories for Remote Insurance Utilization Review jobs in Kentucky are:
What cities in Kentucky are hiring for Remote Insurance Utilization Review jobs? Cities in Kentucky with the most Remote Insurance Utilization Review job openings:
Remote Insurance Utilization Review jobs near you
Medical Billing Customer Support 2nd SHIFT REMOTE

Medical Billing Customer Support 2nd SHIFT REMOTE

Rotech Healthcare Inc.

Murray, KY • Remote

$13.75 - $17.25/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

About Rotech
Join a Leader in Home Healthcare
At Rotech Healthcare Inc., we're more than a medical equipment provider-we're a trusted partner in patient care. As a national leader in ventilators, oxygen therapy, sleep apnea treatment, wound care, diabetic solutions, and other home medical equipment, we empower patients to manage their health from the comfort of home.
With hundreds of locations across 45 states, our team delivers high-quality products, exceptional service, and compassionate support that helps patients live more comfortably, independently, and actively. Whether you're a clinician, technician, or healthcare administrator, your work at Rotech directly improves lives.
Explore more about our mission and services at Rotech.com.
Overview and Responsibilities
Summary
We are seeking a dedicated Customer Support Specialist CPAP Centralized Care Team - REMOTE to join our Rotech team. In this position you will provide support to the customers of the Support Center (patients, referral sources and employees) by performing tasks related to patient care and third party reimbursement. Primarily responsible for new order intake to encompass accuracy with clinical, billing and care related information and processing. First line of contact with new customers.
Pay starting at $16.25 for the 2nd Shift plus a Quarterly Bonus opportunity
  • 2nd Shift Mon - Fri 11:30am - 8pm CST
  • 100% REMOTE Work from Home starting day one
Essential Job Duties and Responsibilities
(Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.)
  • Brings ideas for process or efficiency improvements to supervisor
  • Builds relationships with locations, field management, patients and referral sources
  • Collects co-pays and deductible amounts
  • Conducts insurance verification and eligibility for services/products
  • Conducts patient satisfaction calls and acts as patient advocate to resolve questions or concerns
  • Develops and maintains a working knowledge of current products and services, Medicare, Medicaid, insurance regulations, and FDA/DOT and JCAHO guidelines
  • Maintains accuracy and quality control throughout patient contact and data entry
  • Manages all aspects of initial intake: answering the phone and receiving faxes, collecting patient and referral source information, inputting data into IMBS and eIntake, printing tickets, assembling charts and processing paperwork
  • Obtains authorization and qualification documentation
  • Prepares complete and accurate files for Billing Department
  • Processes new orders, responds to questions, resolves issues or forwards to appropriate personnel in a timely manner to ensure patient, referral, and employee satisfaction
  • Processes work orders to field locations and coordinates timely fulfillment of products and services ordered
  • Provides product/service information and education by answering questions, offering assistance
  • Provides thorough review and Quality Assurance for medical necessity and documentation requirements of payors and regulatory bodies
  • Works extensively with eIntake proprietary system
  • Performs other duties as assigned

Qualifications
Employment is contingent on
  • Background check (company-wide). Results will not be used automatically to disqualify individuals. Instead, the Company will conduct an individualized assessment that considers the duties of the position, the nature and timing of the offense, and any evidence of rehabilitation, in accordance with applicable laws.
  • Drug screen ( when applicable for the position )
  • Compliance with healthcare facility credentialing process ( when applicable for the position )
  • Valid driver's license in state of residence with a clean driving record (when applicable for the position)
Required Education and/or Experience
  • High school diploma or GED equivalent, required
Preferred Education and/or Experience
  • Experience with medical equipment, preferred
  • Experience with medical billing practices and of billing reimbursement, preferred
  • Experience in healthcare administration, patient intake, or insurance verification , preferred
  • One year of related work experience, preferred
  • Medical terminology, preferred
Skills and Competencies
  • Accurately perform simple mathematical calculations
  • Effectively communicate in English; both oral and written
  • Interpret a variety of communications (verbal, non-verbal, written, listening and visual)
  • Maintain confidentiality, discretion and caution when handling sensitive information
  • Multi-task along with attention to detail
  • Self-motivation, organized, time-management and deductive problem solving skills
  • Work independently and as part of a team
Machines, Equipment and Technical Abilities
  • Email transmission and communication
  • Internet navigation and research
  • Microsoft applications; Outlook, Word and Excel
  • Office equipment; fax machine, copier, printer, phone and computer and/or tablet
Physical Demands
  • Lift and carry office equipment at times
  • Requires sitting, walking, standing, talking and listening
  • Requires close vision to small print on computer and/or tablet and paperwork

Rotech Information
Benefits
  • Generous paid time off and paid holidays
  • Overtime pay for non-exempt positions (as applicable)
  • Commission for Account Executives
  • Bonus and incentive opportunities
  • Fixed and variable car reimbursement for Area Managers and Account Executives
  • Car, mileage, and telephone reimbursement (as applicable)
  • Employee discount and recognition programs
  • Employee Assistance Program (EAP)
  • 401(k), HSA, and FSA/Dependent Care FSA
  • Medical, prescription, dental, and vision coverage
  • Life insurance, disability, accidental death, identity protection, and legal services
  • Meru Health mental health and Mercer SmartConnect Medicare programs
  • Livongo Diabetes and High Blood Pressure programs
  • Healthcare Bluebook and RX Savings Solutions programs
  • Hepatitis B (HEPB) and TB vaccinations
Make the right move-submit your resume today . Hiring managers review resumes and contact applicants whose experience aligns with the position. To check the status of a role you've applied for, Sign into your account .
All positions are posted for a minimum of five (5) days and remain open until filled by a qualified applicant, generally no longer than 200 days. Thank you for your interest in Rotech Healthcare Inc.
Florida applicants - Background screening is required through the Florida Care Provider Background Screening Clearinghouse : https://info.flclearinghouse.com/
Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individuals with Disabilities. Rotech Healthcare Inc. recruits, employs, trains, promotes, transfers, separates from employment and compensates employees without regard to membership in, association with, or perception of race, color, age, gender, gender identity, religion, creed, national origin, ancestry, citizenship, marital status, veteran status, sexual orientation, physical or mental disability, pregnancy or any other personal characteristic protected by applicable federal, state and local laws governing nondiscrimination in employment in each locality where Rotech has employees.

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