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Remote Insurance Utilization Review Jobs in Pooler, GA

Bottom Line Construction

Estimator

Savannah, GA · On-site +1

Savannah, Georgia (Remote Flexibility Available) Company: Bottom Line Construction Job Summary ... Review plans, specifications, bid documents, and project requirements. * Support all ...

SilverSwing ABA

ABA Clinic Director (BCBA)

Savannah, GA · On-site +1

$100K - $110K/yr

Relocation Stipend * Full-time on site, designated remote-work days quarterly * Health/dental ... Lead case reviews, deliver performance evaluations, mentor clinicians * Drive growth, partner with ...

ABB

Senior Project Engineer

Bloomingdale, GA · Remote

$90K - $117K/yr

The work model for this role is: Remote {#LI-Remote} This role is contributing to the ... Vision benefit * Company paid life insurance (2X base pay) * Company paid AD&D (1X base pay)

DataAnnotation

FP&A Manager - AI Trainer

Savannah, GA · Remote

$50 - $60/hr

Enjoy the flexibility of remote work and the freedom to set your own schedule. This is an ... In this role, you might: • Review and improve AI Assistant answers to questions about macro ...

DataAnnotation

M&A Associate - AI Trainer

Savannah, GA · Remote

$50 - $60/hr

Enjoy the flexibility of remote work and the freedom to set your own schedule. This is an ... In this role, you might: • Review and improve AI Assistant answers to questions about macro ...

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All JobsInsurance Utilization Review JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Pooler, GA

Remote Insurance Utilization Review information

See Pooler, GA salary details

$19

$38

$62

How much do remote insurance utilization review jobs pay per hour?

As of Jul 23, 2026, the average hourly pay for remote insurance utilization review in Pooler, GA is $38.41, according to ZipRecruiter salary data. Most workers in this role earn between $30.34 and $44.13 per hour, depending on experience, location, and employer.

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 Pooler, GA? For Remote Insurance Utilization Review jobs in Pooler, GA, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Pooler, GA look for? The top searched job categories for Remote Insurance Utilization Review jobs in Pooler, GA are:
What cities near Pooler, GA are hiring for Remote Insurance Utilization Review jobs? Cities near Pooler, GA with the most Remote Insurance Utilization Review job openings:
Remote Insurance Utilization Review jobs near you
Certified Coder/ Biller

Certified Coder/ Biller

Georgia Eye Institute of the Southeast LLC

Richmond Hill, GA • On-site, Remote

$15.50 - $19.75/hr

Other

Medical, Dental, PTO

Posted 6 days ago

Georgia Eye Institute rating

4.8

Company rating: 4.8 out of 10

Based on 7 frontline employees who took The Breakroom Quiz

Job description

Description

Job Title: Certified Medical Coder/Biller

Location: Richmond Hill, GA | Hybrid Remote

Employment Type: Full-time

Reports to: Billing Manager

Department: Revenue Cycle Management


Job Summary: 

The Certified Medical Coder/Biller is responsible for accurately submitting claims to insurance companies, ensuring timely reimbursement for medical services provided by the healthcare facility. This role involves reviewing patient bills for accuracy and completeness, resolving any billing issues, and communicating effectively with patients, insurance companies, and healthcare providers. The ideal candidate will have strong attention to detail, excellent organizational skills, and a solid understanding of medical billing processes and insurance guidelines.


Key Responsibilities:

1.   Claims Processing:

Prepare and submit accurate and timely insurance claims for services rendered.

Verify patient insurance coverage and ensure correct billing to the appropriate payer.

Review and process Explanation of Benefits (EOBs) and insurance payments.


2.   Billing and Coding:

Ensure that all medical services are accurately coded according to current guidelines (CPT, ICD-10, HCPCS).

Work closely with healthcare providers to ensure that documentation supports the services billed.

Resolve discrepancies or issues with coding and billing practices.


3.   Payment Posting:

Post payments and adjustments to patient accounts accurately.

Reconcile daily billing activities and ensure all transactions are properly recorded.

Monitor and follow up on unpaid claims and patient balances.


4.   Patient Communication:

Respond to patient inquiries regarding billing and insurance coverage.

Explain billing policies and procedures to patients and assist with payment arrangements if needed.

Resolve patient billing complaints in a professional and timely manner.


5.   Insurance Follow-Up:

Track and follow up on outstanding claims to ensure timely payment.

Appeal denied claims and work with insurance companies to resolve issues.

Maintain detailed records of claim statuses and correspondence with insurance providers.


6.   Compliance:

Ensure compliance with all federal, state, and local regulations, as well as organizational policies and procedures.

Stay current on industry changes and updates related to medical billing, coding, and insurance regulations.

Participate in internal audits and implement corrective actions as necessary.


7.   Reporting:

Generate and analyze billing reports to monitor revenue cycle performance.

Provide regular updates to management on billing activities, challenges, and successes.

Assist in the preparation of financial reports related to billing and collections.


 Work Environment:

  • Office Setting: This position can work in an office setting with standard hours.
  • Remote Work: We do offer a hybrid schedule if interested. 
  • Physical Requirements: Ability to sit for extended periods, use a computer, and perform repetitive tasks.

Compensation and Benefits:

  • Competitive salary based on experience.
  • Comprehensive benefits package, including health and dental insurance.
  • Paid time off (PTO). 
  • Opportunities for professional development and advancement.


Requirements

Qualifications:

  • High school diploma or equivalent; Associate's degree in a related field preferred.
  • Certification in Medical Billing and Coding (e.g., CPC, CCA) is required.
  • Minimum of 2 years of experience in medical billing or a related role.
  • Strong knowledge of insurance guidelines, including Medicare and Medicaid.
  • Proficiency in medical billing software and electronic health records (EHR) systems.
  • Excellent communication and interpersonal skills.
  • Ability to work independently and manage multiple tasks effectively.
  • High level of accuracy and attention to detail.
  • Strong problem-solving skills and ability to handle billing issues professionally.

What Georgia Eye Institute employees say

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