Non-Clinical Utilization Review (UR) Coordinator - Remote in Bali

Join MedRisk Philippines as a Non-Clinical Utilization Review (UR) Coordinator and become part of a dynamic team revolutionizing healthcare management! We are seeking a detail-oriented, organized professional to support our utilization review processes remotely from the comfort of your home in Bali. MedRisk Philippines is a global leader in healthcare management, specializing in utilization review and medical necessity. With a strong focus on quality and efficiency, we are committed to enhancing the healthcare experience for both providers and patients.

As a Non-Clinical Utilization Review (UR) Coordinator, you will play a crucial role in our team. Your daily tasks will involve reviewing medical records, assessing the necessity of medical services, and ensuring compliance with insurance and regulatory requirements. You will work closely with healthcare providers, insurance companies, and other stakeholders to streamline the utilization review process. This role offers a unique opportunity to make a significant impact on the healthcare industry while working in a supportive and collaborative environment.

📋 Tanggung Jawab Pekerjaan

• Reviewing medical records and insurance claims to assess the necessity of medical services.
• Collaborating with healthcare providers to ensure compliance with insurance guidelines and regulatory requirements.
• Communicating with insurance companies and other stakeholders to resolve discrepancies and ensure accurate claim processing.
• Utilizing software such as Epic, Cerner, or similar healthcare management systems to streamline the utilization review process.
• Providing data analysis and reporting to support decision-making and improve the efficiency of the utilization review process.
• Staying up-to-date with industry trends, regulations, and best practices in healthcare management.
• Mentoring and training junior staff to ensure the continued success of the utilization review process.
• Ensuring the confidentiality and security of patient information in accordance with HIPAA and other relevant regulations.

🎓 Kualifikasi & Syarat

• Bachelor's degree in healthcare administration, business administration, or a related field.
• Minimum of 3 years of experience in utilization review or a related healthcare management role.
• Strong knowledge of insurance guidelines, regulatory requirements, and medical necessity standards.
• Proficiency in using healthcare management software such as Epic, Cerner, or similar systems.
• Excellent communication and interpersonal skills, with the ability to work collaboratively with healthcare providers, insurance companies, and other stakeholders.
• Strong organizational and analytical skills, with the ability to manage multiple tasks and priorities effectively.
• Certification in healthcare management or a related field is a plus.
• Fluency in English, both written and spoken, is required.

🛠️ Keahlian

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