UTILIZATION REVIEW TECH I
The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. The Utilization review tech will further support the department needs for Release of Information, discharge coordination or other duties as assigned.
SAINT MARY'S EMPLOYEES MUST BE EMPLOYED IN THEIR CURRENT POSITION A MINIMUM OF SIX MONTHS AND HAVE NO DISCIPLINE WITHIN THE PAST SIX MONTHS TO BE ELIGIBLE FOR CONSIDERATION.
EDUCATION, EXPERIENCE, TRAINING
- Minimum one year denials management experience in acute care setting highly preferred.
- High School Diploma or equivalent required. Associates degree or higher preferred.
- Accurate alphabetic, numeric, and/or terminal-digit filing skills.
- Computer data entry with 10-key, with accurate typing speed of 35 wpm required. Excel skills highly preferred.
- Knowledge of terminal digit filing and medical terminology; preferred.
- Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.
- Completion of a medical terminology course; preferred.
- Background in business and office training; preferred.
We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law:[ Link removed ] - Click here to apply to UTILIZATION REVIEW TECH I - UTILIZATION MANAGEMENT