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Utilization Review Specialist Remote Jobs in Indiana

micro1 AI

Cheminformatics Specialist - Remote

Carmel, IN · Remote

$80 - $110/hr

Remote micro1 is engaging Computational Biology & Cheminformatics Experts to contribute their ... Assess and review AI-generated outputs for scientific rigor, accuracy, and practical relevance ...

Great American Insurance Group

$110K - $120K/yr

The candidate hired for this position will work from an office in their home with occasional travel to claims reviews and meetings in the Pacific Region. Candidate hired for this position will be ...

Ovationhealthcare

Specialist, Billing

Goshen, IN · Remote

$17.25 - $23.25/hr

Review claims that are pended for edits and resolve. * Prepare and submit accurate claims for ... Work from home and remote location with a stable internet connection, a quiet and dedicated ...

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Utilization Review Specialist Remote information

What is a utilization review specialist?

Utilization Review Specialists (Remote) are healthcare professionals who work from home to evaluate the necessity, appropriateness, and efficiency of medical treatments and services. They review patient records, medical documentation, and insurance information to ensure healthcare services meet established guidelines and regulations. Their goal is to help manage healthcare costs while ensuring patients receive appropriate care, often acting as a liaison between healthcare providers, insurance companies, and patients.

How does a utilization review specialist typically collaborate with healthcare providers and insurance companies?

As a remote Utilization Review Specialist, you’ll frequently interact with healthcare providers and insurance representatives via phone, email, and secure digital platforms. Collaboration often involves reviewing patient records, clarifying clinical details, and ensuring documentation meets payer requirements. Maintaining clear, timely communication is crucial for resolving discrepancies and facilitating care authorizations. Most organizations utilize electronic health record (EHR) systems and case management software to streamline these interactions and support remote teamwork.

What are the key skills and qualifications needed to thrive as a utilization review specialist?

To thrive as a Utilization Review Specialist (Remote), you need expertise in clinical guidelines, medical terminology, and case management, often backed by a nursing or healthcare-related degree and relevant licensure. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance policies or regulatory compliance is typically required. Strong analytical thinking, attention to detail, and effective communication are crucial soft skills for this role. These skills ensure accurate case evaluations, regulatory adherence, and effective collaboration with healthcare providers and payers.

What are popular job titles related to Utilization Review Specialist Remote jobs in Indiana?

For Utilization Review Specialist Remote jobs in Indiana, the most frequently searched job titles are:

What job categories do people searching Utilization Review Specialist Remote jobs in Indiana look for?

The top searched job categories for Utilization Review Specialist Remote jobs in Indiana are:

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Cities in Indiana with the most Utilization Review Specialist Remote job openings:

Utilization Review Specialist Remote jobs near you

Coder Specialist - Remote

Beacon Health System

Granger, IN • On-site, Remote

Full-time

Re-posted 18 days ago

Beacon Health System rating

6.7

Company rating: 6.7 out of 10

Based on 145 frontline employees who took The Breakroom Quiz

532nd of 895 rated healthcare providers

Job description

Reports to the Manager, Coding & Records. Reviews, codes, and analyzes medical records in order to abstract relevant data from patient medical records into the on-line computer system. Assigns DRGs to Medicare, Medicaid, and other required payors. Determines DRG and APC assignment on outpatient and inpatient records. Maintains productivity and accuracy levels for the assigned job code.
This is a remote position; however, candidates must reside in one of the following states: Indiana, Michigan, Illinois, Kansas, Ohio, Georgia, Kentucky, Florida, Idaho, Minnesota, Tennessee, Wisconsin, Colorado, South Carolina, North Carolina, or Texas.
MISSION, VALUES and SERVICE GOALS
  • MISSION: We deliver outstanding care, inspire health, and connect with heart.
  • VALUES: Trust. Respect. Integrity. Compassion.
  • SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Reviews and analyzes discharged patient medical records to ensure all applicable patient data is available for coding and abstracting by:
  • Checking the diagnosis and procedure to ensure accurate coding and sequencing as specified by established coding principles and guidelines, following AHA, AHIMA, and CMS coding guidelines for outpatient and inpatient records.
  • Obtaining accurate and complete patient data through the review of the medical record, discharge summary, history and physical, consultation, progress notes, laboratory, radiology, operative and pathology reports.
  • Coding all procedures on inpatient records (all payors) and outpatient surgical records according to ICD-9-CM Codes, CPT-4 or Physician E&M (Evaluation & Management) Level Code (as applicable).
  • Referring questionable diagnoses and sequencing issues to the physician for clarification.
  • Communicating with the Patient Accounts staff and coordinating with department Manager any questionable abstract or coding problems.
  • Assigning ICD-9-CM Codes and completing a coding summary.
  • Reviewing and evaluating error messages and all incompatible DRGs to the manager or coordinator for a second level review.
  • Completing medical records for abstracting. Resolving any medical necessity related issues.

Completes medical record data entry duties by:
  • Abstracting diagnosis and procedure codes into the Hospital computer system according to specified guidelines.
  • Designating APC assignment on outpatient medical records.
  • Assigning accurately, when applicable, a DRG or APC to Medicare, Medicaid and other required payor's records with the assistance of various computerized grouper software.
  • Abstracting professional E&M codes, professional procedure codes, and technical component procedures into the Hospital computer system charging module according to specified guidelines.
  • Accurate and timely entry of charges on ED and OBS charts according to guidelines if applicable.

Ensures accurate and up-to-date coding by:
  • Quarterly internal and external auditing.
  • Reviewing Coding Clinic and attending coding workshops to enhance coding skills.
  • Billing software edits.
  • For the coding of diagnostic reports, a productivity standard of 250 reports is to be met and medical necessity holds resolved (based upon an 8 hour work day).
  • For the coding of inpatient, ambulatory surgery/observations and emergency records, one of the following productivity standards must be met (all include data entry and are based upon an 8 hr work day):
  • Inpatient Records: Certified Specialist (greater than 25)
  • Ambulatory Surgery/Observation Records: Cert Spec (greater than 60)
  • Emergency Records Facility Records: Certified Specialist (greater than 90)
  • Emergency Records Professional Records: Certified Specialist (100-120)

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:
  • Completing other job-related duties and projects as assigned.
ORGANIZATIONAL RESPONSIBILITIES
Associate complies with the following organizational requirements:
  • Attends and participates in department meetings and is accountable for all information shared.
  • Completes mandatory education, annual competencies and department specific education within established timeframes.
  • Completes annual employee health requirements within established timeframes.
  • Maintains license/certification, registration in good standing throughout fiscal year.
  • Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
  • Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
  • Adheres to regulatory agency requirements, survey process and compliance.
  • Complies with established organization and department policies.
  • Available to work overtime in addition to working additional or other shifts and schedules when required.

Education and Experience
  • The knowledge, skills and abilities as indicated below are normally acquired through the successful attainment of certification as a CCS (Certified Coding Specialist), and maintenance of the certification is required. Designation as a Certified Specialist requires the completion of course work in medical terminology, anatomy, physiology and comprehensive knowledge of ICD-9-CM and CPT-4 coding principles. Attainment of certification as either RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), CCS (Certified Coding Specialist), CCS-P (Certified Coding Specialist-Physician), CPC (Certified Professional Coder), or CPC-H (Certified Professional Coder-Hospital) as well as knowledge and training in more than two work types. Three years of inpatient coding and/or CPT ambulatory surgery coding experience and the ability to mentor and train other coders is required. Three years advanced medical and surgical coding experience in a large acute care facility is preferred.

Knowledge & Skills
  • Requires knowledge of medical terminology, anatomy and physiology necessary to code patient medical records utilizing established but specialized technical coding processes.
  • Requires knowledge of the fundamentals of DRG assignment and optimization.
  • Requires knowledge of state and federal regulatory guidelines for reimbursement in the prospective payment system in order to interface with physicians.
  • Requires the analytical skills to compile and process patient information abstracted from patient records.
  • Requires familiarity with computer data entry.
  • Requires accurate typing skills of at least 40 w.p.m.
  • An accuracy rate of 92% for inpatient and outpatient records is required for the Level I and II position. An accuracy rate of 95% for inpatient and outpatient records is required for the Coding Specialist position.
  • Demonstrates the interpersonal and communication skills (both verbal and written) necessary to interact with staff, physicians, and others.

Working Conditions
  • Works in an office environment.
  • May experience some mental/visual fatigue from careful and constant review of records, code books, and continued use of computer equipment.

Physical Demands
  • Requires the physical ability, motor coordination and stamina to perform the essential functions of the position.

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