Clinical Denial/Utilization Management Assistant

Overview

We are representing a confidential healthcare organization seeking a Clinical Denial/Utilization Management Assistant to join their revenue cycle operations. This role provides critical support to clinical denial management and utilization review teams, ensuring timely payer communication, authorization tracking, and appeal documentation. You'll work with EPIC work queues, communicate with insurance payers, and help maintain the systems that drive clinical appeal processes.

Responsibilities

• Maintain and utilize EPIC work queues to drive payer notification and authorization for patient stays
• Communicate with insurance payers via telephone, fax, and email to ensure clinical requests are submitted timely and thoroughly
• Review denial letters from payers and document them into denial management software, EMR systems, and tracking tools
• Submit all appeal documents to payers accurately and in a timely manner
• Organize and maintain clinical appeal documents, databases, and records systematically
• Review appealed cases to ensure payment is received and notify the clinical denials management team of new findings
• Gather data for reporting purposes and handle assigned projects and reviews
• Screen incoming calls, faxes, and digital communications related to clinical denials and route appropriately
• Interact with hospital staff, providers, and financial personnel regarding determinations, appeals, and denials
• Support process improvement initiatives to create efficiencies within the denial management workflow

What We're Looking For

• Experience in healthcare revenue cycle, utilization management, or clinical denial management preferred
• Familiarity with EPIC systems and electronic medical records highly desirable
• Strong organizational skills with attention to detail and ability to maintain systematic records
• Excellent written and verbal communication skills for payer and internal stakeholder interactions
• Ability to work collaboratively with clinical and administrative teams
• Proficiency with denial management software and tracking tools
• Understanding of insurance authorization processes and appeal workflows
• Strong time management skills and ability to meet deadlines in a fast-paced environment
• Data entry accuracy and ability to gather information for reporting

How We Work with You

Our talent team at Get A Job.ai partners with leading healthcare organizations to connect qualified candidates with meaningful opportunities. When you apply through our platform, one of our recruiters will review your qualifications and conduct an initial screening. If there's a strong match, we'll submit your profile to our client for consideration. Please do not contact the employer directly—we manage all communication throughout the hiring process to ensure the best experience for you.

Pay

Compensation details will be discussed during the screening process based on your experience and qualifications.

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