- Medical
- Dental
- Vision
- Pharmacy
- Health Reimbursement Account (HRA)
- Life and AD&D
- Retirement Plan
- Employee Assistance Program (EAP)
- Flexible Spending Account (FSA)
- Travel Assistance & ID Theft Protection
- Voluntary Benefits
- The COVID vaccine and the Flu shot (during Flu season) are a condition of employment.
- Snoqualmie Valley Hospital is a drug-free workplace. We complete drug screenings as a part of our onboarding process.
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Utilization Review Assistant - Snoqualmie, United States - Snoqualmie Valley Hospital
Description
Job Description
Job DescriptionSalary: $18.58-$27.80Come join our Team Come join Snoqualmie Valley Health, voted the No. 1 Place to Work in 2022*
Snoqualmie Valley Health is always looking for people who want to make a difference, not just within their team, but also in the community. Possibilities are applauded, Innovation and Creativity are encouraged and the Sharing of Ideas is welcomed.
We want you to love what you do, and to succeed. Our entire hospital will support your work and embrace the energy you bring to SVH.
Located at the base of the Cascades in a pioneering, adventure-loving town, SVH is an independent public hospital district serving Snoqualmie Valley and the greater East King County community.
*Snoqualmie Valley Record Readers Poll, December 2022.
1.0 FTE
OBJECTIVE SUMMARY: This position provides administrative support to the Medical Unit, focusing on processes that support the eligibility of the patient stay and continued care plan. In conjunction with the Intake and Referral team, performs functions that assure insurance coverage for an inpatient stay. This position coordinates utilization review functions with the team and provides daily monitoring and updates to the patients EMR regarding eligibility for continued care. This position communicates with the Multidisciplinary Care Team to assure timeliness of eligibility, length of stay, and impacts to discharge plans.
ESSENTIAL FUNCTIONS:
• Determines each patient's insurance eligibility and benefits, verifying via websites or contacting insurance companies.
• Completes necessary forms and/or submits portal data required for pre-authorizations, swing bed/acute inpatient authorization to insurance.
• Follow up on outstanding authorization requests and submit required information for continued stay requirements per insurance policies as necessary.
• Conducts initial, concurrent, and retroactive review with payers.
• Discuss cost of service, any potential out of pocket costs with patient
• Creates and completes preadmission criteria in EMR.
• Assist and follow up with Medicaid Notice of Admissions
• Manages patient's EMR with updated eligibility, co-pays, and other health plan information.
• Communicates with insurance providers to assure timely provision of clinical information through the EMR, portals and other data bases used for inpatient care
• Communicates with the team when there are issues impacting the patient's length of stay and covered days; works with the team to resolve or address any issues to continued care
• Communicates with patients and families as requested by the care team, to address questions or information needed to support length of stay or discharge planning related to insurance eligibility status.
• Communicates with Revenue Cycle Team related to denials, or changes in authorization status
• Attends department staff meetings and in-services as requested by unit Manager
• Other duties as assigned
REQUIRED EDUCATION: A High School diploma or equivalent is required. A completed course in medical terminology is required
PREFERRED EDUCATION: Two years of college with an emphasis in business preferred
REQUIRED EXPERIENCE: One (1) year experience in insurance verification, pre-certification, billing, or related insurance experience is required
ADDITIONAL ELIGIBILITY QUALIFICATIONS: CPR certification required within 6 months of hire
SKILLS:
· Computer literacy, which includes the ability to perform basic entries, with extreme accuracy into the patients EMR in a timely manner
· Ability to navigate insurance and other business portals as necessary to obtain appropriate information to support admission and length of stay
· Excellent communication skills (oral and written)
· Excellent commitment to customer service and patient satisfaction
BENEFITS:
We take pride in the benefits package we provide our team members. Snoqualmie Valley Hospital offers you one medical plan with multiple in-network tiers with Snoqualmie Valley Hospital, Eastside Health, and First Choice/First Health providers/network.
Eligibility Requirements - Employees regularly scheduled at least 20 hours per week.
Employee Dependents - Your legal spouse or domestic partner, Dependent children until age 26.
Waiting Period - 1st of the month following 30 days from your date of hire.
PLEASE NOTE:
