Utilization Management Specialist - Menomonee Falls, United States - APN Software Services Inc

Description

Job Description

DUTIES:

The Utilization Management Specialist provides clerical support to the Utilization Review and Preauthorization teams to assist with patient transitions. Provides payor documentation through the provision of information to payors, documentation of authorizations and payor clinical information requests in the electronic health record.

1. Initiates Notice of Admission and responsible for account conversion status changes and monitoring/correcting insurance information changes in the Electronic Medical Record (EMR). Supplies all requested concurrent clinical review documents to insurance companies via fax or other established portal per payor contract. 2. Documents accurate clinical and financial information in the EMR while working in assigned work queues. Assigns coordination of care follow-up to the appropriate team/providers for ongoing coordination of care. Communicates with payor in timely fashion based on contract requirements. Accurately and timely documents communication from payors and third party administrators in the EMR to assist with continuing care services. 3. Performs clerical support services including faxing, data entry, filing, telephone answering, emails follow-up, voice mail retrieval. Provides verbal and written communication to team members, patients, and families regarding coordinated services. Communicates with case manager or physician advisor when appropriate to gather necessary information being requested by the payor. Monitors current patients' hospital service and registration status errors and communicates needs for follow-up with the care team, as needed. 4. Identifies and offers solutions regarding day-to-day workflow in collaboration with other ancillary departments. 5. Acts as site administrator for payor websites. Maintains and assigns security access to payor websites for Hospital staff ancillary departments. 6. Other duties as assigned.

SKILLS:

A minimum of three (3) years of related experience is required. Analytical skills necessary to obtain information from patients and families, external customers, and ability to interact professionally with internal and external customers including hospital personnel and peers required. Good organizational skills. Excellent communication skills. Effective application of Microsoft Office products, document imaging. Experience working in a hospital billing office and/or admitting, health insurance and managed care program, Medicare and managed care denial management experience, preferred. Billing and clinical coding or medical terminology coursework, preferred. Associate or Bachelor's degree in healthcare related field, preferred

EDUCATION:

High School diploma or equivalent is required