Coordinator Utilization Review Care Management

Job Description

Salary: 23.92-35.88 USD

Facility: Administrative Regional Training Cntr

Shift: Shift 1

Status: Full Time FTE: 1.000000

Bargaining Unit: ACE Associates

Exempt from Overtime: Exempt: No

Work Schedule: Days with Rotation

Hours:

Primary 9-5pm with rotation to 8-4pm

Summary:

This position is accountable for the document management, workflow, and data entry of the concurrent review process associated with the management of communication received from the payers. This individual specializes in ensuring the concurrent review process is followed, evaluates what is needed to resolve a denial, resolves when able or delegates to the appropriate party to handle with follow up performed through completion. This individual also works to ensure that all concurrent review data is maintained to the highest standard to maintain data integrity. This includes, but is not limited to, responding to inquiries, complaints, and other correspondence, and may include setting up arbitration between parties. Knowledge of state and federal laws relating to contracts and appeal processes is vital. Maintains and directs processes and systems used to track, monitor clinical denials and workflows within finance and the revenue cycle.

Responsibilities:

EDUCATION AND EXPERIENCE

• Associates Degree in Healthcare related field required or a minimum of five (5) years of previous health care related experience accepted in lieu of degree

KNOWLEDGE, SKILL AND ABILITY

• Sharp decision making
• Strong sense of accountability
• Excellent interpersonal (verbal and written) communication and networking skills
• Ability to organize and prioritize multiple responsibilities
• Exceptional use of computer applications, including Excel and MS Word and knowledge to generate reports and correspondence
• Exceptional computer skills and ability to learn and navigate electronic systems
• Excellent reporting capabilities with data entry, extraction and manipulation with integrity
• Proficient operation of standard office equipment (scanner, fax, copier, printer, telephones)

WORKING CONDITIONS

ENVIRONMENT

• General office environment