Remote Utilization Review Manager Jobs in Georgetown, KY

At UK St. Claire, our staff is our greatest asset in the mission to create a healthier and more prosperous population. We strive to foster the talent and potential of our employees and prioritize safe working conditions and equal compensation rates to ensure that continual growth is possible. UKSC is a nurturing workplace for all healthcare professionals. We invite you to explore our current job openings and see if our opportunities could be the right fit for you.
Job Description:
Job Summary
Responsible for managing moderate-complexity patient account activities to optimize reimbursement and reduce accounts receivable. Provides expertise in billing, follow-up, collections, and/or denials resolution to improve financial outcomes. Ensures accuracy of charge, claim, and payment data through reviews and targeted corrections. Recommends workflow improvements, reporting insights, and queue management practices that elevate productivity. Coordinates cross-functional problem solving with coding, clinical, and payer partners to support organizational financial objectives.
Essential Functions
• Provides expertise in billing, follow-up, collections, and/or denials resolution. Performs timely follow-up on outstanding claims and appeals to meet aging and recovery targets.
• Reviews charge, payment, and adjustment activity to identify variances and initiate corrective action.
• Reconciles patient balances and payer remittances to ensure accurate application of payments and adjustments.
• Communicates professionally with stakeholders regarding estimates, statements, and complex balance questions.
• Collaborates with coding, authorization, and utilization review teams to resolve documentation and coverage gaps.
• Maintains compliance with HIPAA, FDCPA, and payer contract provisions in all actions.
• Performs other duties as assigned.
Education Requirement: High school diploma or equivalent
Experience Requirement: 2-3 years of experience
An equivalent combination of education and experience may be considered. All experience must be paid and in the same related field. Part-time and PRN experience will be prorated based on hours worked per week. Volunteer work and internships for academic credit are not counted.
Certifications & Licensures: N/A
Working Conditions
A. Lifting, pushing, and/or pulling objects up to 50lbs:2. Occasional (< 10% of the time)
B. Lifting, pushing, and/or pulling objects over 50lbs:1. Never
C. Standing or walking with objects up to 10lbs:3. Intermittent (10% - 50% of the time)
D. Standing or walking with objects up to 25lbs:2. Occasional (< 10% of the time)
E. Sitting at the computer workstation for extended periods:3. Intermittent (10% - 50% of the time)
F. Risk of back injury from moving, lifting or positioning patients, equipment, or materials:2. Occasional (< 10% of the time)
G. Repetitive motion:3. Intermittent (10% - 50% of the time)
H. Working at heights above 4 feet:1. Never
I. Working in confined spaces:1. Never
J. Risk of injuries from use of equipment on the job:2. Occasional (< 10% of the time)
K. Job-related travel:2. Occasional (< 10% of the time)
L. Loud noises:1. Never
M. Temperature extremes:1. Never
N. Hazardous chemicals and fumes including waste:2. Occasional (< 10% of the time)
O. Radiation:1. Never
P. Burns:1. Never
Q. Cuts/Punctures:2. Occasional (< 10% of the time)
R. Bloodborne/airborne pathogens:2. Occasional (< 10% of the time)
S. Recombinant DNA or viral vectors:1. Never
T. Combative/violent people:1. Never
U. Animal handling (including carcasses):1. Never
V. Please specify other(s) and amount of exposure (i.e. Occasional, Intermittent or Regular): N/A
Physical Demands
This position requires intermittent sitting at a computer workstation for extended periods of time; performing tasks with repetitive motions (such as typing); intermittent standing or walking with objects weighing up to 10 pounds; occasional standing or walking with objects weighing up to 25 pounds; and occasional lifting, pushing, or pulling objects weighing up to 50 pounds.
Department:
Denials
Shift:
Days (United States of America)
Time Type:
Full time
Address:
2317 Alumni Park Plaza
City, State:
Lexington, Kentucky