Utilization Review Support Specialist

day, daytime hours, holiday rotations required.
• Hybrid Work Location: Forsyth Medical Center, Winston-Salem, NC.
• Provide administrative and technical support to the Utilization Review team to ensure timely payer communication, authorization tracking, and accurate documentation.
• Manage daily operations of the onsite Utilization Review (UR) office, including processing mail, answering phone inquiries, making calls to verify authorizations and denial determinations, and faxing communications for multiple facilities.
• Process denials within a strict timeframe and manage payor work queues to avoid adverse determinations.
• Facilitate EMR access by sending census reports to payors.
• Process large volumes of confidential patient and payer information to support billing workflows (includes managing payor communications, processing authorizations, addressing denials, and indexing faxes).
• Facilitate Condition Code 44 Medicare Outpatient Observation Notice (MOON letter) as outlined by Medicare guidelines, providing education and support to patients and families.
• Establish and maintain effective work relationships with both internal and external customers.
• Maintain compliance and regulatory standards and organizational policies.

What You Will Need

Required:
• High School Diploma or GED.
• One or more years of clerical AND healthcare experience.

Preferred:
• Knowledge of Microsoft Office products with proficiency in Excel and Word.
• Strong clerical/administrative skills in a healthcare environment.

What’s In It for You:
• Comprehensive benefits include medical, dental, vision, and life insurance.
• Retirement fund with matching contributions.
• Tuition assistance for qualifying team members.
• Employee assistance programs and discounts.

What We're Looking For
• Additional Skills (required): Excellent interpersonal and customer service skills. Working knowledge of personal computers and software including specific knowledge of Microsoft office products. Perform clerical duties with accuracy. Proficient spelling and grammatical skills. Attention to detail with excellent planning and organizational skills. Communicate effectively in both oral and written forms. Keyboard/type accurately. Ability to operate standard office equipment including, but not limited to, a calculator, fax machine, copier, printer and scanner. Establish and maintain effective work relationships. Ability to successfully complete generic and department specific skills validation and competency testing.

Why Choose Novant Health?

At Novant Health, we believe remarkable care starts with compassion for our patients, our communities, and each other. We value belonging, courage, personal growth, and teamwork, creating a space where everyone is respected, supported, and safe to show up as their full selves.

Job Opening ID

157589