Utilization Review Assistant

Clinical Document-Coding Mgmt

The Utilization Review Assistant will:

• Obtain insurance company (payer) logs, telephone messages from payers, and any other payer communication within expected time-frames.
• Utilize available medical record and case management software records, identify the Patient Account identifier (Financial number), dates of service (admission/discharge) and unit location and room number for patients currently occupying a bed.
• Identify requests for clinical information and verifies if information has been successfully submitted to the requested contact number.
• If clinical review present but not submitted or not submitted to the payer making the request, complete the electronic process for accurate payment transmission.
• Communicate, according to expected guidelines, with the Care Coordination Nurse regarding all requests for new clinical review or additional information requests.
• Communicate, according to expected guidelines, with the designated Department staff regarding denials or payer determinations other than approved.
• Identify discrepancies in payer determination and current status and initiate communication as per guidelines.
• Enter approved, denied, or overturned days into the case management documentation platform.
• Assist with initiating requests for Peer to Peer discussion as directed by Physician Advisor or designated Care Coordination staff.
• Assist with preparation and documentation for secondary physician review including obtaining paper consults and progress notes and attaching electronically with review and additional electronic utilization review information.
• Identify actual and potential barriers to providing the requested information to the payer within the expected timeframe for securing payment. Escalation and communication including the means of receipt of the payer request (telephonic, letter, log, email)
• Maintain and update as needed the payer contact directory in the case management documentation platform.
• Provide notifications and updates as relevant to the Care Coordination Department staff including changes in payer designated contacts, schedule changes, holiday closures, vacation cross-coverage.
• Establish and maintain positive working relationships with Care Coordination staff, representatives from Admissions & Registration, Patient Accounts, and dedicated payer contacts.
• Other duties as assigned.
  
  

Requirements:

• Ability to accurately type.
• Strong computer keyboarding and data entry skills and experience with computerized programs and processes; ability to utilize multiple patient record systems.
• Strong customer service, interpersonal, and communication skills.
• Flexible and able to work both independently and as part of a team.
  
  

Salary Range: 18.00 - 26.58 USD

We offer competitive base rates that are determined by many factors, including job-related work experience, internal equity, and industry-specific market data. In addition to base salary, some positions may be eligible for clinical certification pay and shift differentials.

The salary range listed for exempt positions reflects full-time compensation and will be prorated based on employment status.

Saint Peter's offers a robust benefits program to eligible employees that will support you and your family in working toward achieving and maintaining secure, healthy lives now and into the future. Benefits include medical, dental, and vision insurance; savings accounts, voluntary benefits, wellness programs and discounts, paid life insurance, generous 401(k) match, adoption assistance, back-up daycare, free onsite parking, and recognition rewards.

You can take your career to the next level by participating in either a fully paid tuition program or our generous tuition assistance program. Learn more about our benefits by visiting our site at Saint Peter's .