Description
The Utilization Management Extender supports front-end utilization management workflows with direct revenue impact by validating admission authorizations, notifications, level-of-care changes, concurrent reviews, and payer documentation. The role reconciles authorization activity, resolves discharged-not-billed and billing-hold issues, responds to payer correspondence, tracks authorization trends, escalates complex issues, and collaborates with utilization management, revenue integrity, coding, HIM, billing, and patient access teams. It requires a high school diploma or GED, prior utilization management experience, knowledge of CMS, AHCA, and managed care authorization requirements, proficiency with Epic and payer portals, and strong analytical and communication skills.
