Utilization Review Representative - Full Time

Job Description

Job Description

Description : Job Summary

Performs patient insurance verification and authorization functions for Specialty Service, Surgical Services, Sub-Acute Rehab admissions, Radiology Departments. Assist patients with their benefits, and other departments as assigned. Identifies patient’s copay / deductible responsibilities for Specialty Service, Surgical Service and Radiology Departments. Assists Specialty Services department with the completion of Workman’s Compensation forms having patient balance inquiries.

• Prepares pre-registration paperwork for scheduled Radiology, Specialty Services and Surgical Services procedures on a daily basis to prioritize daily workflow, reviewing for accuracy and completeness; distributes this information among department(s) as needed. Prioritizes insurance verification needs and registration support to facilitate the data processing required for add-on and stat procedures. Provides prior authorization or notifications to insurance companies for OBS, I / P, and Swing admits as needed.
• Conducts insurance verification for assigned pre-registrations to validate insurance data, identify patient responsibility and confirm that proper authorization is obtained. Confirms insurance eligibility and demographic information, and communicates this information to the appropriate area. Clearly documents this information in the patient account and communicates this information to the Registration Department to facilitate up front collection efforts.
• Utilizes all tools and resources currently available to streamline the workflow of financial viability, including, Availity, Epaces, Medical Necessity, and any third party related telephone and internet sources. This includes all available Worker’s Compensation portals.
• Works collaboratively with Central Registration, Scheduling and Patient Finance to ensure accurate and timely claim submission. Resolves impediments to billing.
• Assists follow up staff with development and submission of technical / administrative appeals based on denial activity. Works closely with Case management to resolve clinical denials. Track issues, appeals, outcomes and and trends via denial tool.
• Communicates with payers to address related concerns. Reports all communication to the department manager.
• Informs registration and other departments of discrepancies prior to rendering service where possible. Clearly documents and communicates key information in the hospital system.
• Promotes / portrays a high level of professionalism, both technically and personally. Possesses strong work ethic and exhibits optimism. Adheres to the departmental dress code policy and maintains a professional appearance and positive attitude.
• Keeps knowledge base current on billing regulations and insurance carrier policies and procedures to ensure that efficient and accurate patient and billing information is obtained.

All job requirements listed indicate the minimum level of knowledge, skills and ability deemed necessary to perform the job proficiently. This job description is not to be construed as an exhaustive statement of duties, responsibilities or requirements. Employees will be required to perform other job-related instructions given by their supervisor, subject to reasonable accommodation.

Hours : Full Time, Day Shift

Salary : $18.74 - $21.38 per hour based on experience.

Company Overview :

Ellenville Regional Hospital is a non-profit, community focused hospital based in New York’s Hudson Valley. We support our local community with health, wellness, specialty services and readily available diagnostic testing. We are centrally located for residents in surrounding areas to access our subacute rehabilitation programs, specialists and ambulatory services. Our healthcare is delivered with compassion and respect based on our commitment to improving our community health through excellence, innovation and state-of-the-art technologies.

Benefits :

Health Insurance

Vacation Time

Requirements : Experience :

Education :

Certification / Skills :

Salary : $19 - $21