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Job Type:
RegularScheduled Hours:
24Job Summary:
The Utilization Review Technician provides support and assistance to the Utilization Management Review Nurses in the Care Coordination Department. Receives communication from payers and relays it to appropriate healthcare team member, assisting in obtaining payer authorization for acute care services rendered to patients.Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.
Job Description:
- Organizes and documents information from payers and other parties per phone and fax lines.
- Communicates appropriate information from payers to Utilization Management staff.
- Enters data in patient chart financial screens.
- Such as authorization numbers or denial information
- Audits charts
- To ensure accurate capture of revenue and utilization information from procedure charges
- To optimize the accuracy of the facility charge. Requires analytical and process management approach.
- Accurately enters audit results into the software system.
- Identifies accurately reason for visit and procedures performed.
- Corrects erred charges in the billing system.
- Observes Department needs.
- Through own assignment assessment, with direction from Team Leader or Manager
- Works closely with members of the management team to identify potential lost reimbursement opportunities due to missing or inaccurate clinical documentation and resolve reimbursement issues in order to protect and properly use the systems assets.
- Manages incoming mail by sorting and sending paper documents to appropriate department
- Actively participates in professional development
- Attends staff meetings
- Engage in educational opportunities to maintain professional competence
- Identifies education needs/opportunities
- Performs other duties as assigned.
- Willingly accepts routine and additional assignments and demonstrates timely follow-through on their completion.
Education, Credentials, Licenses:
- High School Diploma
Specialized Knowledge:
- Knowledge of medical terminology
- Demonstrated data entry skills with knowledge of various software applications.
- Ability to analyze and interpret clinical data.
- Ability to demonstrate good oral and written communication skills.
- Ability to organize and prioritize multiple tasks
Kind and Length of Experience:
- 3 years healthcare related experience
FLSA Status:
Non-ExemptRight Career. Right Here. If you're looking for the right careers in healthcare, the right place to be is at St. Elizabeth. Join us, and you'll take pride in the level of care we offer our community.
