Insurance Utilization Coordinator

1 week ago

New York, New York, United States Mount Sinai Health System Full time
Job Overview
As an Insurance Utilization Coordinator, you will be responsible for the assessment and management of patient care plans, ensuring that services are delivered in a timely and appropriate manner.
Key Responsibilities
  • Oversee the concurrent review program, including insurance certification and authorization processes for Psychiatric and Chemical Dependency Inpatient Units, as assigned by management.
  • Establish and maintain effective working relationships with admitting and inpatient clinical teams to ensure comprehensive clinical information is available for timely reviews and authorizations.
  • Communicate regularly with Hospital Insurance Verification and Patient Accounts teams to ensure prompt verification of patient insurance status.
  • Facilitate insurance authorizations by providing necessary clinical documentation and developing relationships with insurance case managers to enhance authorization outcomes.
  • Collaborate with clinical staff to ensure timely discharge planning when insurance authorizations are nearing expiration, exploring appropriate alternatives with the care team.
  • Monitor and coordinate alternative levels of care in conjunction with the Utilization Management Manager and clinical leadership.
  • Notify inpatient services of any delays to minimize length of stay and enhance quality of care.
  • Generate reports and maintain data for regulatory compliance and Utilization Management activities.
  • Demonstrate the necessary knowledge and skills to provide care tailored to the physical, psychosocial, and educational needs of patients.
  • Utilize various hospital management systems effectively and coordinate updates with relevant departments.
  • Refer cases to external agencies for appeals as needed.
  • Prepare documentation for concurrent reviews and appeals, ensuring compliance with regulatory timelines.
  • Identify and escalate problematic utilization and quality issues to management.
  • Maintain accurate records of approvals, denials, and appeals in collaboration with management.
  • Prioritize insurance requests and respond to inquiries to prevent denials and recover payments.
  • Request and provide medical records as necessary for appeals and insurance reviews.
  • Manage denial and appeal processes as directed by management.
  • Assist with mail processing related to Utilization Management activities.
  • Supervise support staff as required.
Qualifications
A Master's degree is preferred, along with relevant experience in the field.
Technical Skills:
Proficiency in MS Word, Excel, and Access, with the ability to learn additional applications as needed.
Highly organized and articulate, demonstrating sound judgment and excellent interpersonal skills.
Ability to work independently with minimal supervision.
About Mount Sinai Health System
Mount Sinai Health System is dedicated to fostering a diverse and inclusive environment, committed to delivering exceptional patient care. We invite you to explore how you can contribute to our mission of advancing health for all people.

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