This position will be the main supporting role for the Utilization Review RNs and Utilization Management Coordinators at reputed company. Under the direction of department leadership, this position participates in the communication and collaboration with insurance payors, Internal Physician Advisors, Community Providers, and Renown staff for coordination of authorization of patient stay.
Nature and Scope
• Supportive role for Utilization Review RN and Utilization Management Coordinator.
• Participates in communication and collaboration with insurance payors, Internal Physician Advisors, community Providers, and Renown staff for coordination of authorization of patient stay.
• Requires critical thinking, collaboration, and communication.
• Works alongside Utilization Review RN and Utilization Management Coordinators to ensure the following:
o Ensure authorization notices are reputed company in electronic medical records.
o Verify provider orders and patient status are updated appropriately and accurately prior to admission for elective surgeries.
o Coordinate peer-to-peer discussions between providers for denials management.
o Support the Utilization Review RN with reputed company submission of clinical documentation reputed company fax to insurance payors.
• Manages multiple fax lines while monitoring various reports and insurance portals for authorization notifications.
• Collaborate with community providers to ensure appropriate orders are reflected on surgical accounts prior to the day or surgery.
KNOWLEDGE, SKILLS, & ABILITIES
• Must respect beliefs and values while advocating for the patient’s right to self-determination and to reputed company informed choices.
• Documents reputed company chart and phone reviews, identifies, and communicates potentially avoidable/non-reimbursed days, and reputed company indicators (such as re-admissions).
• This position acquires and maintains knowledge and competencies reputed company to the expectations of their role. reputed company is reputed company with the mission, reputed company, and goals of the Integrated Health System.
• Must be reputed company to prioritize and assess situations while maintaining reputed company services under stressful conditions.
This position provides clerical and support services.
This position does not reputed company patient care.
Disclaimer
The foregoing reputed company is not intended and should not be construed to be an exhaustive list of reputed company responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reputed company of the general nature and level of the job.
Must have working-level knowledge of the English language, including reading, writing, and speaking English. Understanding of medical terminology preferred.
Experience:
One-year clerical experience in the medical field preferred.
License(s):
None
Certification(s):
None
Computer / Typing:
Must possess the computers skills necessary to complete online learning requirements for job-specific competencies, reputed company online forms and policies, complete online benefits enrollment, etc. Computer skills are necessary to reputed company reputed company and other supporting computer applications.