Utilization Management Insurance Liaison

3 weeks ago

Canandaigua, United States Thompson Health Full time

Description

Are you looking to make a real difference in the lives of others in an empowering and supportive work environment? Join our growing and well respected community health system and enjoy competitive pay, high patient and staff satisfaction levels, excellent infection control support and compliance, free parking, tuition assistance and other excellent benefits

*Remote or in person opportunity (must be available for occasional on-site visits)

Schedule: Full time, days.

Main Function:

  • The Utilization Management Insurance Liaison is responsible for managing the submission of clinical documentation to insurance companies for hospital admissions.

  • This position tracks insurance approvals and denials, coordinates appeals and peer to peer discussions between the hospital providers and the insurance companies.

  • This role ensures compliance with CMS regulations, NYS regulations and insurance company policies.

  • This position acts as liaison to the business office and other hospital departments.

  • The Insurance Liaison supports the Utilization Management team by completing administrative tasks and assisting with coverage of select tasks when other members of the team are on vacation or leave.

Required Job Specific Competencies:

  • Demonstrates understanding of state and federal regulations as pertains to Utilization Review and demonstrates familiarity with payer-specific guidelines.

  • Demonstrates ability to work independently as well as part of team.

  • Demonstrates the ability to develop and maintain collaborative working relationships with associates, leaders, medical staff and outside agencies.

  • Exhibits flexibility in decision-making and prioritizes workload responsibilities.

  • Demonstrates strong problem-solving skills.

  • Demonstrates great attention to detail and organizational skills.

  • Demonstrates interpersonal skills, professional manner and excellent communication.

  • High standard of medical & business ethics.

  • Actively guards the confidentiality of sensitive information including but not limited to the patients, staff, and the health system.

  • Demonstrates time-management skills with the ability to multi-task.

  • Demonstrates ability to use many software products including EHRs, Microsoft products, and other software/programs to assist with data analysis.

  • Demonstrates comprehensive knowledge of insurance plans, member eligibility, medical billing with understanding of CPT, ICD-10 and medical terminology.

  • Demonstrates ability to meet deadlines.

  • Always lives the CARES values.

Qualifications:

  • High School Graduate or equivalent required.

  • Associate or Bachelor’s degree preferred.

  • 1-3 years’ experience in a healthcare environment required.

  • Strong communication & organizational skills

  • Strong Computer skills

  • Previous experience reviewing and analyzing denials, claims and rejections preferred.

  • Previous experience with reimbursement systems, DRGs/APCs, medical billing CPT codes, ICD10 coding guidelines preferred.

Pay Range: $19.00 - $24.00

Starting Rate: Based on experience

Thompson Health is an EOE encouraging women, minorities, individuals with disabilities and veterans to apply

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

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