General Summary:

To support the Holy Cross Health goal of preventing medical necessity write offs through clear and timely communication with third party payers of appropriate utilization; to coordinate with the Physician Advisor, other members of the Documentation Quality team and Care Management staffs to support and evaluate utilization review activities; and to facilitate Medicare compliance activities related to inpatient utilization regulations and Patient Privacy..

Requires interdepartmental communication with Care Management at HCH and HCGH as well as Revenue Cycle departments and third party payers.

Supports the Mission of CHE Trinity Health and Holy Cross Health.

Minimum Knowledge, Skills, and Abilities Required:

• Bachelor’s degree.
• Experience working in a healthcare organization preferred.
• Knowledge of health care systems; knowledge of pertinent regulatory requirements (The Joint Commission, Federal/State government).
• Excellent verbal and written communication skills
• Excellent interpersonal skills and ability to work on a team.
• Strong computer skills and able to employ data oriented software (i.e. Excel)
• Reads, writes, speaks and comprehends the English language.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.