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Utilization Review Support Specialist Lead

Cone Health
United States, North Carolina, Greensboro
Feb 27, 2026
The Utilization Review Support Specialist Lead oversees the daily functions of the Utilization Review Specialist Support Team and serves as the main contact for admission notification questions, escalation, and procedures. The Lead is responsible and accountable for the timely resolution of complex issues, training and continuous education of the team through development and implementation of standard work that maximizes reimbursement outcomes. Essential Job Function Manage and guide the daily operations of the utilization review support team, ensuring proper staffing and service levels that lead to positive reimbursement outcomes. Makes recommendations to management that will maximize and enhance reimbursement outcomes, account management skills, eliminate inefficiencies and support staff knowledge and understanding. Ensure continuous team operations by stepping in for team members during their periods of absence, maintaining workflow and service levels. Act as a key point of contact to support team members and collaborate with other departments in addressing and resolving complex account situations. Maintain a current working knowledge of latest updates from payers and government agencies/regulations. Implement process improvements as necessitated by changes from payers or government mandates, which includes training team members, implementing workflow changes, and updating department leadership. Responsible for the creation, maintenance and management of standard operating procedures and documentation for the assigned team. Conducts quality audits of designated work queues and work assignments, implements necessary process improvements, and communicates findings to team and management to improve staff proficiency and prevent errors. Performs other duties as assigned. Education Required: High School Diploma or equivalentPreferred: Associates Degree Experience Required: 3 years on medical office billing or hospital registration/billingPreferred: 5 years Revenue Cycle experience Licensure/Certification/Listing