Top 27 Utilization review Jobs in New Haven Ct

Insurance Reimbursement Specialist
Aspira Labs, Inc. —Shelton, CT
- Full-time
- Microsoft Word
- Microsoft Excel
- HIPAA
Quick Apply
3rd Shift Registered Nurse (12:00am - 8:00am Tuesday-Saturday)
Connecticut Renaissance —Waterbury, CT
- $47.43 an hour
- Full-time
- Background check
- Nursing
- Addiction Medicine
- Loan repayment program
- Health insurance
Quick Apply
Clinical Case Manager
Waterbury Hospital —Waterbury, CT
- Part-time
- Nursing
- RN License
- Hospital
RN-Case Manager
Yale New Haven Health —Bridgeport, CT
- Weekends as needed
- Nursing
- RN License
- Hospital
Case Manager
Waterbury Hospital —Waterbury, CT
- Full-time
- Nursing
- RN License
- Hospital
5d
Care Coordinator (RN) - Social Work
MidState Medical Center —Meriden, CT
- Full-time
- Acute care
- Nursing
- RN License
Quick Apply
Community Support Specialist
Rushford —Meriden, CT
- Full-time
- HIPAA
- Mid-level
- Residential
- Paid holidays
- Health insurance
Quick Apply
5d
MDS Coordinator
Advanced Center for Nursing and Rehabilitation —New Haven, CT
- Full-time
- Nursing
- Skilled nursing facility
- RN License
Quick Apply
Director of New Prospects
RECOVERY NETWORK OF PROGRAMS, INC. —Bridgeport, CT
- On call
- LMFT
- Writing skills
- Licensed Clinical Social Worker
Quick Apply
3d
MDS Coordinator
Aaron Manor Nursing and Rehabilitation Center —Chester, CT
- $40 - $48 an hour
- Part-time
- Nursing
- Skilled nursing facility
- RN License
- Paid training
- 401(k)
Quick Apply
Community Support Specialist - Bilingual (Spanish)
Rushford —Meriden, CT
- Full-time
- Spanish
- HIPAA
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Director of Nursing Services
Ark Healthcare and Rehabilitation at Branford Hills —Branford, CT
- Full-time
- CPR Certification
- Nursing
- RN License
Quick Apply
Director of Tina Klem Serenity House
RECOVERY NETWORK OF PROGRAMS, INC. —Bridgeport, CT
- Full-time
- LMFT
- Psychiatry
- Writing skills
Quick Apply
3d
Principal Psychiatrist (DMHAS) (Office/On-Site)
State of Connecticut - Department of Mental Health & Addiction Services —Bridgeport, CT
- $253,879 - $331,255 a year
- Part-time
- Medicine
- Psychiatry
- Addiction Medicine
2d
Principal Physician (40 Hour)
State of Connecticut - Department of Correction —Cheshire, CT
- $247,686 - $323,175 a year
- Weekends as needed
- Medicine
- Surgery
- Psychiatry
- Paid training
- Paid holidays
Principal Psychiatrist (40 Hour)
State of Connecticut - Department of Correction —Bridgeport, CT
- $253,879 - $331,255 a year
- Weekends as needed
- Psychiatry
- Addiction Medicine
- Research
- Health insurance
- Dental insurance
Utilization Management Reviewer
Amerihealth Caritas —United States
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Health insurance

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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
4d
Specialist, Utilization Review
Columbus Springs East —Columbus, OH
License: Current unencumbered clinical license strongly preferred. UR contacts external case managers/managed care organizations for certification of insurance…
Quick Apply

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utilization review jobs near new haven ct

Insurance Reimbursement Specialist

Aspira Labs, Inc.
Shelton, CT

Quick Apply

Job Details

Full-time

Qualifications

Microsoft Word
Customer communication
Microsoft Excel
Accounts receivable management
Word embeddings
HIPAA
Medicare regulations
Healthcare privacy protection
Health information regulatory compliance
Medicaid regulations
Medicaid

Full Job Description

Job Title: Insurance Reimbursement Specialist

Department: Billing

Reports To: Revenue Cycle Manager

Location: Shelton, CT

Terms: Full-time

FLSA Status: Exempt

POSITION SUMMARY

As an Insurance Reimbursement Specialist, you will work with insurance and billing companies to process medical reimbursements for patients. Your primary duties include claim review, appeal generation, interacting with patients, communicating with insurance providers, assist with retrieving EOBs, and other duties as assigned. To be successful in this role, you need strong analytical, communication, and organizational skills.

ESSENTIAL FUNCTIONS

Responsible for submission of appeals to national payers
Provide review of all levels of an insurance appeal
Gather supporting documentations (physician medical records, patient /physician letters etc.)
Work incoming correspondence from payors to assist with claim appeal
Interact with utilization review/management departments
Assist with gathering EOB’s if cash poster is unable to locate
Provide excellent customer service via the handling of inbound and outbound calls/emails to patients and providers
Data Entry
Assist with Error Processing when business volume dictates the need

PERFORMANCE MEASURES

Review claim denials within 1 week of posting to determine next step for accession
Submit request to provider for necessary documentation for appeal- follow up on requests within 2 weeks if not received.
Submit accessions for adjustments per Patient Transparency Program guidelines and document accession to reflect need for adjustment accurately
Follow up with plans when trends of nonpayment or incorrect payment is received per contracts
Utilize portals/fax/USPS to submit appeals for claim review when necessary. USPS should be last resort if portal/Fax unavailable
Provide payor status updates when issues arise to leadership
Review Sfax for documentation relating to payor groups daily
Review correspondence at the time of working denials to verify if we received essential information for the claim.
Provide response to patient and client emails/voicemails within 24 business hours of receipt and document account appropriately
Adherence to schedule
Productivity based on accuracy and quality
Maintain a positive, achievement-oriented attitude and influence others to do the same
Demonstrate high ethical standards and personal integrity
Display a commitment to personal growth

MINIMUM QUALIFICATIONS

College degree preferred or equivalent but will substitute for applicable work experience
Minimum two (2) years’ experience in healthcare accounts receivable environment; knowledge of medical terminology, billing, and coding a plus
Demonstrate proficiency in Microsoft Word and Excel
Adhere to Medicare, Medicaid Compliance and HIPAA guidelines in relation to PHI information

KNOWLEDGE, SKILLS, AND ABILITIES

Exceptional analytical and organizational skills
Ability to work independently, a team player with strong interpersonal skills to effectively interact with all levels of employees
Superior time management and critical thinking skills
Ability to work under pressure and achieve goals efficiently
Strong written and verbal communication skills
Dependable, flexible, and adaptable in all aspects of work

SUPERVISORY RESPONSIBILITES

No direct supervisory responsibilities

Quick Apply

Refine Your Search

utilization review jobs in new haven ct

Insurance Reimbursement Specialist

3rd Shift Registered Nurse (12:00am - 8:00am Tuesday-Saturday)

Clinical Case Manager

RN-Case Manager

Case Manager

Care Coordinator (RN) - Social Work

Community Support Specialist

MDS Coordinator

Director of New Prospects

MDS Coordinator

Community Support Specialist - Bilingual (Spanish)

Director of Nursing Services

Director of Tina Klem Serenity House

Principal Psychiatrist (DMHAS) (Office/On-Site)

Principal Physician (40 Hour)

Principal Psychiatrist (40 Hour)

Utilization Management Reviewer

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