Utilization Review Assistant

UnityPoint Health St. Lukes

Requisition ID
2020-84293
Category
Quality
Location
US-IA-Cedar Rapids
Address
1026 A Ave NE
Affiliate
1010 UnityPoint Health CR St Lukes Hospital
City
Cedar Rapids
Department
Case Management
State
IA
FTE
1.0
FLSA
Non-Exempt
Scheduled Hours/Shift
M-F 0800-1700
Work Type (Portal Searching)
Full Time Benefits

Overview

Under the guidance and supervision of the utilization management nursing staff, the associate is responsible for the maintenance and utilization of Epic work queues that drive payer notification and authorization for patient stays. The associate communicates with payers via telephone, fax, or email and is responsible for ensuring clinical requests are sent in a timely manner and in a thorough fashion. The associate is expected to acquire an understanding of prior-authorization, verification, and benefit coordination for payers and proceeds with authorization and documentation as delegated. The associate assists with patient notification regarding level of care and appeal rights per CMS regulations.

Responsibilities

· Answers telephone; screens calls and callers, referring them to the appropriate person.

· Creates a welcoming environment for person’s served. Effectively manages positive relationships with referral sources and other members of the team.

· Manages and coordinates pre-authorizations for services as needed. Sends requested documentation to third party payers for prior authorization and reauthorization of patient visits.

· Monitors and completes accounts on multiple work queues in EPIC, including referrals and denials.

· Maintains designated filing and record keeping systems. Assists with preparation of reports, graphs, and statistical information.

· Performs other related secretarial and clerical functions as requested.

· The associate is aware of hospital and department compliance for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of department or hospital administrative staff.

· Purposefully conducts all aspects of the job in an ethical manner in support of the hospital’s commitment to ethical behavior in all areas of personal and professional activity.

· Successfully completes hospital-wide orientation, annual hospital competencies and department/unit specific competencies.

· For the safety of our patients and co-workers, St. Luke’s Hospital requires seasonal and job related vaccinations. This is reviewed regularly during periodic health assessments.

· Distributes notification letters to, provides education to, and secures signatures from patients per CMS regulations surrounding admission status and right to appeal discharge.

Qualifications

A. Education

· High school graduate required, associate’s degree preferred

 

B. Qualifications/Experience

· Writes, reads, comprehends and speaks fluent English

• Keyboard accuracy/speed of at least 60 words per minute

• Basic computer knowledge and skills

• Experience in Microsoft Word, Excel, Power Point and Outlook preferred

• Prior secretarial experience in a medical environment preferred

• Prior insurance knowledge preferred 

Job ID: 72446

Posted 15 days ago

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