Utilization Review Specialist (Remote)

Utilization Review Specialist Remote
Are you looking for a career opportunity with a fast-growing company that helps to transform lives? If so, then youve come to the right place. Invicta Health Solutions, a business division of RSi, seeks a full-time Utilization Review Specialist to augment our growing RCM team. As a Utilization Review Specialist, you have the unique opportunity to advocate for patients and their families, while working hand in hand with hospital personnel to review medical records and ensure adjudication from Government, Commercial, and TPL insurance carriers. Invicta incorporates artificial intelligence with human interaction to secure funding and provide a dynamic patient experience. Come join team!
Invicta Health Solutions is a Revenue Cycle Management division of Receivable Solutions, LLC (RSi); headquartered in Columbia, South Carolina with employees, clients, and partners all over the United States. The purpose of our Invicta division is the relentless innovation of RCM processes for the benefit of others. Our leadership team is committed to developing tomorrows leaders from within, so we balance technical development with life and leadership skill-building. Successful employees embrace and cultivate these characteristics: customer service excellence; fail fast and forward; tech-forward; diversity, equity, and inclusion advocacy; goal-oriented; community citizenship; and team play.
Position Summary:
We are looking for a Utilization Review Specialist who specializes in Commercial and Government Carriers, Authorizations, Appeals, and has complete knowledge of Hospital Revenue Cycle Management. As a Utilization Review Specialist, you will provide leadership to designated areas of responsibility, including direction and supervision of Recovery staff. This leader will continuously develop all client relationships to ensure the organization is meeting and exceeding all revenue targets and client expectations.
Key Accountabilities:
Encourage a healthy work culture and environment by modeling positive, creative, and customer-focused characteristics
Mentor team members to grow skill and prepare for future growth with the company
Maintain effective, efficient, and productive operational workflow
Work with senior leadership to produce defined financial results within a dynamic healthcare environment which meet and/or exceed customer requirements and company profitability goals.
Enforce disciplinary action as warranted concerning any employee misconduct.
Manage and develop a team to match resource needs.
Respond to daily questions and concerns raised by client in a timely and responsible manner.
Responsible for adjusting staff duties as may be required to accommodate procedural changes or additional needs that may occur.
Adhere to and supports organizational standards, policies, and procedures.
Perform other duties as assigned.
Skills/Abilities/Experience & Qualifications:
Current LVN or LPN License
Ability to pass a thorough background check
Authorized to work for any employer in the United States
Exceptional customer service skills
Demonstrated communication, problem solving and case management skills, and the ability to act/decide accordingly.
Proficient with technology such as phone systems, computers, Microsoft software applications such as Word, Excel, Outlook, etc.
Excellent written and verbal communication skills

Preferred Skills:
Strong knowledge of Medicaid, Medicare, TPL, and Commercial insurance recovery practices
Medical Record review and diagnostics
Prior and Retro Authorizations
Appeal creation for all major payers
Out-of-State Medicaid Recovery procedures
Strong knowledge of major hospital systems
Physical Demands/Working Conditions:
Work will be primarily performed remotely. Candidates must have a stable dedicated workspace and secure internet connectivity. Computer equipment will be provided by the Company. Requires prolonged sitting, standing, or walking. Requires on-camera interactions with colleagues, leadership, and occasionally, clients. Consequently, appropriate work attire and professional setting is required. Requires eye-hand coordination and manual dexterity enough to operate a computer keyboard, photocopier, telephone, calculator, and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 15 pounds occasionally. Work may be stressful at times. Must be an effective communicator with strong problem resolution abilities. Travel to Invicta Health Solutions Division offices and/or client facilities may be required from time to time. Training will often be performed on-site in an Invicta office location.

OSHA Category:
The candidate selected for this position will not be required to conduct any medical care. All employees must abide by client-required policies such as wearing masks, providing COVID-19 vaccination status and testing, in the event that any on-site visits occur.

This is a remote position.