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UM Support Tech - Utilization Management

2131 South 17Th Street
Wilmington, NC

Date Posted: Oct 15, 2020

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Job Description

Description

About NHRMC

NHRMC, established in 1967 in Wilmington, NC, is recognized as a preeminent healthcare organization focused on leading our community to outstanding health. We have an 855 bed network of hospitals and multi-specialty physician group practices with more than 200 physicians. With a network of primary, specialty, neighborhood clinics and regional medical centers; you will find our culture is the very definition of best in practice. Join us and find out how many ways NHRMC offers you the chance to focus on what really matters - our patients and community.

About the Job

Location: New Hanover Regional Medical Center

Department: Utilization Management

Full Time Equivalent: FTE: 1.000000

Work Type: 64 to 80 Hours Pay Period

Work Schedule: 8HR DAY - Most of shift btwn 7A-3P

Exempt from Overtime: Exempt: No

What You'll Do

Summary:

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.


Responsibilities:

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.

Position Requirements

Credentials:

Education:
Essential:
* High School Diploma

Other information:

Experience: Two years of related work in healthcare environment is required, 4 years preferred. Familiar with medical terminology or has completed a medical terminology course.   

Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence. 

Performs other duties as assigned. 

Individual will possess commensurate combination of education, experience and qualifications. 

Other Information

This position description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications which may be required of the employee assigned to the position. Depending on the location of the job, duties may vary. Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind; my employment with the Company is at will.

  • Member Top 100 Hospitals – In 2016 NHRMC was recognized as a Top 100 Hospital demonstrating significant investment and financial sustainability for the communities we serve. 
  • Newsweek's 2020 list of Best Maternity Care Hospitals - NHRMC Betty H. Cameron Women's & Children's Hospital was named as a Best Maternity Care Hospital by Newsweek. 
  • Forbes America’s Best Large Employers 2018 and 2019Link 
  • Becker’s 150 Top Places to Work in HealthcareLink 
  • Healthgrades Outstanding Patient Experience

Consider a career at NHRMC and become part of this award winning team!

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