Description

II. POSITION SUMMARY:

Under the direction of the Utilization Review Manager, performs internal audits for compliance and program integrity validation purposes. Assists with special projects, report generation, data gathering activities for Inpatient and Outpatient services. The Utilization Review Clerk will participate in the development and maintenance of operational polices and procedures to insure compliance with State and Federal regulatory requirements. Assists with the Maintenance of the UR TAR logs, including processing of TARs and mailing TARs. The Utilization Review Clerk communicates effectively and demonstrates a positive attitude and customer services skills with physicians, staff, and patients.

III. ESSENTIAL FUNCTIONS:

• Assist with TAR completion as needed
• Assist with UR logs
• Assist with Discharge Planning
• Ensure accurate chart documentation to ensure patients meet hospitalization criteria
• Data Entry as required
• Perform audits and gather data for compliance and program process validation as required
• Other duties as assigned
• Receiving incoming phone calls for admissions

Requirements

IV. EDUCATION/EXPERIENCE REQUIREMENTS:

High school graduate or equivalent.

Ability to stay organized and shift priorities as needed to effect the timely completion of the coding workload.

Proficiency in Windows based programs. Especially excel 

Excellent general office skills. 

Communicate effectively in both written and oral formats

Must be able to work independently 

V. PHYSICAL DEMANDS

Physical Activity – Dictionary of Occupational Titles. Strength Rating: L

Working Hazards or Risks – potential for musculoskeletal injuries due to moving or lifting supplies and equipment; potential for exposure to infectious processes and hazardous substances within the hospital environment.

OSHA Blood Borne Risk Category III.