Clinical Coordinator

3 days ago


Aurora, Illinois, United States Mercy Medical Center Full time

Overview

Salary: $55,000 - $65,000 per year">

Mercy Medical Center in Aurora, IL, is a critical care hospital and ER with advanced specialty care services. Our care teams listen to understand your health needs and deliver care that's right for you. We have a level II trauma center and provide advanced surgical care for serious and life-threatening injuries and illnesses.

  • We offer a wide range of minimally invasive procedures using robotic-assisted technology, imaging and lab tests, a dedicated inpatient rehabilitation center, all on one campus.
About the Job">

The Utilization Review Tech plays a vital role in coordinating the utilization review and appeals process as part of our denial management initiatives.

  • This includes coordinating phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals.
  • You will be responsible for documenting and tracking all communication attempts with insurance providers and health plans and scanning all related correspondence to the respective EMR/tracking tool.
  • Our Utilization Review Tech will follow up on all denials while working closely with our Corporate/Facility Utilization review teams, Business Office and Case Managers.
  • This role will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned.
  • You will further support our department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.
Requirements">

To succeed in this role, you will need:

  • A High School Diploma or Equivalent.
  • Microsoft office proficiency.
  • Good communication skills.

Preferred qualifications include completion of a medical terminology course and knowledge of HIPAA regulations.



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