Utilization Management Administrative Support Staff
1 day ago
POSITION SUMMARY
The Utilization Management Administrative coordinator role provides administrative coordination to the Utilization Management staff and Revenue Integrity Team. This position is primarily responsible for assisting the Utilization Review RN, Physician Advisor, Revenue Integrity Team and HIM records release to obtain/validate authorization from the payers for the patients' hospital stays at the appropriate level of care, and to prevent a potentially denied hospital stay. As necessary, this position may also assist in Veracity denials portal to coordinate dispute/appeals for non-paid accounts. Some specific tasks of this role include accessing all payer portal timely, denied and approved accounts, faxing clinical information to the payers and transferring details into MCCM and MMX system for approvals and denials. Daily monitoring of various payer portals and submitting the requested information as directed by Utilization Review Coordinators, providing prompt feedback to both the Utilization Review Coordinators and the Physician Advisor if an authorization is not obtained, to establish peer to peer with PA and payor and documenting the various payer communications in the Care Management Tool.
This position requires high level IT skills, excel expertise, ability to facilitate multiple payor portals, and navigate share site. This position mandates collaboration/interaction with all Utilization Management staff, regular communication with the Physician Advisor, and ongoing collaboration with some of the Revenue Cycle team. This position requires a strong knowledge of medical terminology and the various payers' authorization processes. This position supports organizational goals of providing details to support clean timely compliant claim release and providing quality customer service, participating in performance improvement efforts and demonstrating a commitment to teamwork and cooperation.
QUALIFICATIONS
EDUCATION: Associate's Degree required or High School Diploma with 3 years relevant experience.
EXPERIENCE: Minimum 3 years of relevant experience required, with demonstrated acumen in Medical Terminology and payer authorization processes, payer portal use and access. Strong effective communication skills, excellent organizational and time management skills, and flexibility in responding to multiple demands are required.
PERFORMANCE EXPECTATIONS
Consistently demonstrates the technical and behavioral competencies as established on the Assessment and Evaluation Tool.
Drives process improvement to align with clean, timely, compliant claim release and as well as organizational goals.
Productivity standards are met in payer portals, MMX, Veracity, MCG etc.
WORK ENVIRONMENT
Office environment with limited exposure to infectious disease, hazardous substances and potential injury. This position requires desk/computer work a majority of the time.
REPORTING RELATIONSHIP
This position reports to department leadership.
Pay Transparency In order to support the Fair Compensation Strategy by the US Govt., HR Dept., clients are required to adhere to "Pay Transparency Law"; in the impacted states; that have mandated the employers to list the salary ranges in Job advertisements or postings for job opportunities and Job promotions.
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