Title : Utilization Review Assistant Location : Long Beach Department : Utilization Management MCH OP Status : Full-time Shift : Days, Weekends Pay Range* : $22.

41 / hour - $32.50 / hour At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees.

Memorial Care stands for excellence in Healthcare. Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability.

Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.

Position Summary The Outpatient Utilization Review Assistant, using decision trees and standard work, is responsible for a broad range of utilization review support services to ensure efficient authorization coordination including registering patients, eligibility verification, scheduling patient visits, obtaining authorizations, preparing billing data through data entry in EMR and 3rd party billing systems, maintaining patient information through chart documentation in EMR, preparing required reports and providing other support as requested.

The Outpatient URA is responsible for selecting appropriate chart documents to submit timely requests to government insurances, private health plans, medical groups and IPAs to secure authorizations and documents activities and authorizations per standard work.

The Outpatient URA is able to navigate and understand payer portals for transmission of authorizations. Essential Functions and Responsibilities of the Job Appropriate chart documents are chosen and transmitted per decision trees and standard work to submit for authorization requests.

Provides clerical support services including triaging telephone calls, mailing and faxing correspondences and printing reports.

Obtains initial patient demographics, including referring / ordering physician and third party / guarantor information and documents in EMR per standard work.

Chart documentation is transmitted per department timeliness requirements. Documentation in the billing system of activities and authorizations is complete and timely.

Duties performed meet department productivity requirements. Timely notification (prior to services rendered for elective admissions and within 24 hours and / or the next business day for urgent / emergency admissions) to all insurance / medical groups.

Verify eligibility, obtain benefit plan information and secure authorization when necessary. Communcation of authorization received is sent per standard work.

In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities.

Health and wellness is our passion at MemorialCare-that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family.

And there's more... Check out our MemorialCare Benefits for more information about our Benefits and Rewards.Experience

• 2 years medical office / UR Department / Admitting Central Auth Unit / medical group experience in utilization review, insurance contracts, multi-payer inpatient authorization systems and / or business office operations is required, or 2 years' experience as a Licensed Vocational Nurse.
• Outpatient pediatric clinic experience with knowledge of CCS and Medi-Cal preferred Education
• AA Degree and / or healthcare related certificate course preferred.

Last updated : 2024-05-10