Utilization Review Assistant, Full Time, First Shift, Bethlehem

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

The Utilization Review Assistant is responsible for taking the data provided to their department and using it to communicate necessary information to both the Utilization Review Nurses and insurance companies. Making sure that all necessary information is communicated to the appropriate party in a timely fashion is imperative so that the patients are able to receive the proper level of care and to help ensure coverage for care by the insurance company for services rendered to patients.

JOB DUTIES AND RESPONSIBILITIES:

• Organizes and prioritizes daily work and assigned tasks by assessing new, current, and discharged patients in area(s) of responsibility accurately and within specified time limits.
• Establish and maintain positive and effective communication with other departments to provide needed information on accounts to ensure daily caseload is worked successfully.
• Establish and maintain positive and effective communication with Insurance Nurses to ensure understanding of all individual patient cases.
• Manages telephones, emails, faxes and handles inquiries appropriately.
• Return phone calls to providers and follow up with requests in a timely fashion.
• Scan determinations of all inpatient and outpatient requests.
• Request, process and track high volume of inpatient and outpatient authorization requests for observation and inpatient admissions from insurance companies via phone, fax or insurance online portal for services.
• Fax or upload notifications of admissions, initial and continued stay reviews to the insurance company via EPIC or online portals.
• Actively monitors and completes multiple workqueues.
• Detailed system documentation of admission authorization in the hospital account record.
• Supply insurance companies with discharge dates and dispositions.
• Requests retrospective authorizations on discharged patients as assigned.
• Maintains an active role in denial prevention. Proactively intervenes with payers to prevent inpatient denials.
• Communicates any necessary information to payers to help existing denials.
• Keep leadership advised of status of current patients, in regard to utilization activities through timely documentation and participate in performance improvement activities.
• Provide support to Network Director Utilization Review, Utilization Review Nurses and the Supervisor to Utilization Review Assistants.
• Acts as a liaison with the Registration, Finance Department, Business Office, Physician groups, and all internal/external sources regarding authorizations, denials, and inquiries relative to utilization review.

PHYSICAL AND SENSORY REQUIREMENTS:

Sitting for one to 5 hours per day, 1 ½ hours at a time. Standing for up to 2 hours per day, up to 30 minutes at a time. Walking for up to 30 minutes a day, up to 10 minutes at a time. Frequently uses fingers for typing and writing. Occasionally uses fingers, hands for turning/twisting. Rarely uses the hand for firm grasping. Frequently lifts, carries, pushes and pulls objects up to 10 pounds, occasionally pulls items up to 25 pounds. Frequently stoops, bends, occasionally crouches and reaches above shoulder level. Frequently kneels and squats. Must have the ability to touch as related to telephone and computer keyboard. Must have the ability to hear as it relates to normal conversations and high and low frequencies in person and on the telephone. Has ability for seeing as relates to general vision, peripheral vision and vision monotony. Able to speak clearly as related to communication on the telephone and in person.

EDUCATION:

H.S. Diploma.

Associate degree in the business/secretarial field preferred.

TRAINING AND EXPERIENCE:

A minimum of two (2) year's relevant experience in the healthcare field such as, registration, insurance verification or similar positions required.

Medical terminology experience required.

Pre-authorization and pre-certification experience preferred.

Demonstrates comprehensive knowledge of computer skills in a variety of software programs, i.e. Microsoft Word, Excel, and Power Point.

Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!

St. Luke's University Health Network is an Equal Opportunity Employer.