Pre Access Specialist
Akron, OH · On-site +1
... case management, utilization review, and clinical teams to gather necessary information and ... Remote
Pre Access Specialist
Akron, OH · On-site +1
... case management, utilization review, and clinical teams to gather necessary information and ... Remote
Suitability Review Specialist
Delaware, OH · Remote
$73K - $122K/yr
Strong understanding of annuity and life insurance products, including their features, benefits ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...
Suitability Review Specialist
Delaware, OH · Remote
$73K - $122K/yr
Strong understanding of annuity and life insurance products, including their features, benefits ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...
Suitability Review Specialist
New Hampshire, OH · Remote
$73K - $122K/yr
Strong understanding of annuity and life insurance products, including their features, benefits ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...
Suitability Review Specialist
New Hampshire, OH · Remote
$73K - $122K/yr
Strong understanding of annuity and life insurance products, including their features, benefits ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...
Insurance Service Associate - Remote
Delaware, OH · Remote
$13.75 - $19/hr
... policy reviews, providing insurance quotes for an existing insurance policy and processing ... If working in a remote setting, capability to meet our work from home requirement. * P&C or ...
Insurance Service Associate - Remote
Delaware, OH · Remote
$13.75 - $19/hr
... policy reviews, providing insurance quotes for an existing insurance policy and processing ... If working in a remote setting, capability to meet our work from home requirement. * P&C or ...
Insurance Specialist - Prior Authorization (Remote) - Eastern Time zone
Rocky River, OH · Remote
$18 - $21/hr
... review/updating of patient accounts, etc. Explain charges, answer questions, and communicate a ... Remote
Insurance Specialist - Prior Authorization (Remote) - Eastern Time zone
Rocky River, OH · Remote
$18 - $21/hr
... review/updating of patient accounts, etc. Explain charges, answer questions, and communicate a ... Remote
Optometrist - Remote
Columbus, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Columbus, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
Optometrist - Remote
Toledo, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Toledo, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Cleveland, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Cleveland, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
New Carlisle, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
New Carlisle, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
New Carlisle, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
New Carlisle, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Columbus, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Columbus, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Toledo, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Toledo, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Elyria, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Elyria, OH · On-site +1
Insurance (Medical, Dental, and Vision) * Paid Holidays * 403b Retirement with up to 8% match ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
RN Care Manager PRN
Cleveland, OH · Remote
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
RN Care Manager PRN
Cleveland, OH · Remote
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
Insurance Specialist - Prior Authorization (Remote) - Eastern Time zone
Rocky River, OH · Remote
$18 - $21/hr
The Insurance Specialist - Prior Authorization is responsible for obtaining prior authorizations ... Review accounts for medical necessity, payer requirements, and benefit limitations. * Document ...
Insurance Specialist - Prior Authorization (Remote) - Eastern Time zone
Rocky River, OH · Remote
$18 - $21/hr
The Insurance Specialist - Prior Authorization is responsible for obtaining prior authorizations ... Review accounts for medical necessity, payer requirements, and benefit limitations. * Document ...
Job Title Senior Data Science Consultant, Insurance - Remote Requisition Number R7828 Senior Data ... Coach and mentor junior consultants and review modeling work for quality and rigor. * Support ...
Job Title Senior Data Science Consultant, Insurance - Remote Requisition Number R7828 Senior Data ... Coach and mentor junior consultants and review modeling work for quality and rigor. * Support ...
Job Title Senior Data Science Consultant, Insurance - Remote Requisition Number R7828 Senior Data ... Coach and mentor junior consultants and review modeling work for quality and rigor. * Support ...
Job Title Senior Data Science Consultant, Insurance - Remote Requisition Number R7828 Senior Data ... Coach and mentor junior consultants and review modeling work for quality and rigor. * Support ...
... voluntary life insurance upon first day of employment * 401k program with 6% company match ... utilization. This may include fact-based repair or operational recommendations that enable ...
... voluntary life insurance upon first day of employment * 401k program with 6% company match ... utilization. This may include fact-based repair or operational recommendations that enable ...
Remote Insurance Utilization Review information
What is a remote insurance utilization review?
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 skills and qualifications are needed for a remote insurance utilization review specialist?
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.
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 is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?
| Aspect | Remote Insurance Utilization Review | Remote Claims Reviewer |
|---|---|---|
| Credentials | Typically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professional | Usually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H |
| Work Environment | Remote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of services | Remote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance |
| Industry Usage | Commonly used in healthcare insurance to evaluate medical necessity | Used 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.
What are the most commonly searched types of Insurance Utilization Review jobs in Ohio?
The most popular types of Insurance Utilization Review jobs in Ohio are:
What are popular job titles related to Remote Insurance Utilization Review jobs in Ohio?
For Remote Insurance Utilization Review jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Ohio look for?
The top searched job categories for Remote Insurance Utilization Review jobs in Ohio are:
- Remote Microsoft Nurse
- Online Remote Mds
- Home Based Oasis Reviewer
- Flexible Remote Empathetic Listener
- Utilization Review Clinician Salary
- Volunteer Navihealth Utilization Review
- Remote Physical Therapy Utilization Review
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- Temporary Aetna Utilization Review Nurse
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What cities in Ohio are hiring for Remote Insurance Utilization Review jobs?
Cities in Ohio with the most Remote Insurance Utilization Review job openings:
Full-time
This job post has expired 1 day ago. Applications are no longer accepted.
Akron Children's Hospital rating
7.4
Based on 97 frontline employees who took The Breakroom Quiz
348th of 1,060 rated hospitals
Job description
Full-time, 40 hours/week
11:30am-8:00pm
Fully Remote but Onsite in Mahoning Valley for 60 days training
Summary:
Pre Access Specialist is responsible for performing functions to facilitate the patient's seamless movement through the Revenue Cycle process. This role ensures demographic and insurance requirements are current, supports reimbursement processes, and minimizes claim denials by verifying coverage and communicating details downstream accurately and efficiently.
Responsibilities:
1. Manage Epic work queues and reports for Pre-Access tasks; to make outbound calls or send communications to patients and/or responsibility parties to collect information to update Epic and/or share information within required timeframes, etc.
2. Register complete and accurate demographic, guarantor and financial information to create the patient's record in the system for billing purposes.
3. Verify patient insurance coverage and eligibility using electronic systems or payer portals or phone calls.
4. Process, triage and document incoming calls, voicemails, faxes, and/or emails per standard protocols in the appropriate system or tool.
5. Apply approved scripting for patient interactions and handle unique scenarios professionally.
6. Collaborate with Patient Access team members, clinical departments, case management, utilization review, and clinical teams to gather necessary information and expedite services when needed.
7. Escalate issues related to coverage, status, denials, delays or repeated trends to leadership for review.
8. Create and send estimates as needed or refer cases to Financial Counseling when potential for patient liability exists.
9. Meet departmental standards for productivity, quality, and timeliness.
10. Other Duties as assigned
Other information:
Technical Expertise
1. Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits
2. Strong interpersonal communication skills to support families with empathy and clarity
3. Ability to navigate multiple systems (EHR, payer portals); Epic experience preferred
4. Strong understanding of insurance types (Medicare, Medicaid, commercial, managed care)
5. Excellent communication, organizational, and time management skills
6. Ability to work independently in a fast-paced environment.
7. Familiarity with EHR systems (e.g., Epic, Cerner) and payer portals and guidelines (i.e. Medicaid, managed care, and commercial plans)
Education and Experience
1. High school diploma or equivalent required; associate degree or healthcare certification preferred.
2. Minimum 1 year in a Clinical, Revenue Cycle, Patient Access or Insurance company role that perform work related to; registration, insurance verification, billing, scheduling, patient service rep, customer service, etc. required.
3. Pediatric healthcare access roles preferred.
4. Certification in healthcare access (e.g., CHAA or CMAA) preferred.
5. Experience in hospital admissions or emergency department settings preferred.
• Familiarity with pediatric insurance policies, including Medicaid, managed care, and commercial plans preferred.
Full Time
FTE: 1.000000
Status: Remote
11:30am-8:00pm
Fully Remote but Onsite in Mahoning Valley for 60 days training
Summary:
Pre Access Specialist is responsible for performing functions to facilitate the patient's seamless movement through the Revenue Cycle process. This role ensures demographic and insurance requirements are current, supports reimbursement processes, and minimizes claim denials by verifying coverage and communicating details downstream accurately and efficiently.
Responsibilities:
1. Manage Epic work queues and reports for Pre-Access tasks; to make outbound calls or send communications to patients and/or responsibility parties to collect information to update Epic and/or share information within required timeframes, etc.
2. Register complete and accurate demographic, guarantor and financial information to create the patient's record in the system for billing purposes.
3. Verify patient insurance coverage and eligibility using electronic systems or payer portals or phone calls.
4. Process, triage and document incoming calls, voicemails, faxes, and/or emails per standard protocols in the appropriate system or tool.
5. Apply approved scripting for patient interactions and handle unique scenarios professionally.
6. Collaborate with Patient Access team members, clinical departments, case management, utilization review, and clinical teams to gather necessary information and expedite services when needed.
7. Escalate issues related to coverage, status, denials, delays or repeated trends to leadership for review.
8. Create and send estimates as needed or refer cases to Financial Counseling when potential for patient liability exists.
9. Meet departmental standards for productivity, quality, and timeliness.
10. Other Duties as assigned
Other information:
Technical Expertise
1. Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits
2. Strong interpersonal communication skills to support families with empathy and clarity
3. Ability to navigate multiple systems (EHR, payer portals); Epic experience preferred
4. Strong understanding of insurance types (Medicare, Medicaid, commercial, managed care)
5. Excellent communication, organizational, and time management skills
6. Ability to work independently in a fast-paced environment.
7. Familiarity with EHR systems (e.g., Epic, Cerner) and payer portals and guidelines (i.e. Medicaid, managed care, and commercial plans)
Education and Experience
1. High school diploma or equivalent required; associate degree or healthcare certification preferred.
2. Minimum 1 year in a Clinical, Revenue Cycle, Patient Access or Insurance company role that perform work related to; registration, insurance verification, billing, scheduling, patient service rep, customer service, etc. required.
3. Pediatric healthcare access roles preferred.
4. Certification in healthcare access (e.g., CHAA or CMAA) preferred.
5. Experience in hospital admissions or emergency department settings preferred.
• Familiarity with pediatric insurance policies, including Medicaid, managed care, and commercial plans preferred.
Full Time
FTE: 1.000000
Status: Remote
What Akron Children's Hospital employees say
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About Akron Children's Hospital
Sourced by ZipRecruiter
Akron Children's Hospital has been caring for children since 1890, and our pediatric specialties are ranked among the nation's best by U.S. News & World Report. With two hospital campuses, regional health centers and more than 50 primary and specialty care locations throughout Ohio, we're making it easier for today's busy families to find the high-quality care they need. In 2020, our health care system provided more than 1.1 million patient encounters. We also operate neonatal and pediatric units in the hospitals of our regional health care partners. Every year, our Children's Home Care Group nurses provide thousands of in-home visits, and our School Health nurses manage clinic visits for students from preschool through high school. With our Quick Care Online virtual visits and Akron Children's Anywhere app, we're here for families whenever and wherever they need us. Learn more at akronchildrens.org.
Industry
Hospitals
Company size
5,001 - 10,000 Employees
Headquarters location
Akron, OH, US
Year founded
1890