Works under the direction of the Manager to provide support for utilization management processes. Performs clerical tasks related to the review, denial and appeals process, acts as system administrator for the web-based communication software used for concurrent and retrospective review process, SNF, LTAC referral process.
1.Runs laser arc/IBAX/Series and forwards as needed to appropriate parties.
2.Serves as the liaison for online payer communication system.
3.Enters patient information and payer requests into online payer communication system and links patients to appropriate payer and staff member
4.Researches payer sources if unknown.
5.Requests medical records from the Medical Records for appeals and manages stat scan requests for retrospective reviews.
6.Enters Authorization numbers in UM software system.
7.Tracks recovered dollars from successful appeals in UM software system.
8.Prepares and prints utilization management reports.
9.Assists with appeals process and manages UM mail.
10.Appropriately distributes faxed or telephonic requests to facilitate timely review process.
11.Assists URAs and UM Specialists with sending reviews via online communication system upon request.
12.Communicates billing status changes to appropriate parties.
13.Completes a variety of department specific clerical tasks such as phones, fax, copying to assist with optimal department safety and functioning.
14.Acts as system administrator for web- based communication software for concurrent and retrospective review process, SNF and LTAC referrals; provides training organizationally for expanding departmental use of software; provides ongoing support- serving as resource for software usage.
15.Monitors UM phone line and triages calls to appropriate UM team member.
16.Appropriately communicates information in accordance with hospital policies and procedures.
17.Organizes and performs work effectively and efficiently.
18.Maintains and adjusts schedule to enhance team performance.
19.Maintains UMPA schedules, creating and utilizing resources to ensure UMPAs and Case Manager’s awareness of schedules and contact information; assists with organization of orientation for newly contracted UMPAs.
20.Assists with organization of resources needed for UMPA Letters of Determination.
21.Demonstrates a daily commitment to the values of the department.
22.Demonstrates positive interpersonal relations in dealing with all members of the team
23.Maintains and promotes customer satisfaction.