Utilization Review Coordinator

Bluff Plantation - Augusta, GA

Full-time
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POSITION SCOPE & SUMMARY:

RiverMend Health has an exciting opportunity for a talented professional who will provide daily administrative and professional support that enables claims to be correctly processed and retained in accordance with departmental policies and procedures. The specific functions performed by this role are critical in achieving the Revenue Cycle Team’s overall responsibilities involving timely billing and account follow-up. This national employer is on a fast track towards building sustained excellence, innovative methodologies and superior outcomes. In brief, RiverMend Health is an Employer of Choice pursuing only the best and most qualified talent as full time Insurance Records Processing Specialist.

OUR PROMISE TO YOU:

To provide a Professional environment where employee development is a top priority. Competitive pay and benefits. Growth opportunities. Creativity and out of the box thinking is embraced. Work Life Balance is supported.

MINIMUM QUALIFICATIONS:

  • Education– Bachelor’s Degree in nursing, counseling, social work or an LMSW, LPC or LCSW preferred. Licensed and currently registered in the state you are working.
  • Experience–Minimum of three years of experience hospital utilization review experience in an acute care or clinic setting.
  • Skills– Experience and understanding medical claims, explanation of benefits, utilization/authorization denials or requests for additional information and claim denials is a must. Solid technical skills using computer software applications (Electronic Medical Record/ Medical Billing Systems, SharePoint, Excel, Word, Office 365) and data entry skills, medical necessity knowledge of ASAM, MCG and/or Interqual.
  • Qualifications: Excellent collaborative skills, including a high degree of psychological sophistication and non-aggressive assertiveness, attention to detail and highly organized, confidential, and proven time management. A demonstrated commitment to high professionalism, interpersonal skills, and ethical standards. Strong written and verbal communication skills. Strong organizational, task prioritization and delegation skills.

JOB RESPONSIBILITIES:

Utilization Review Coordinator will coordinate the clinical aspects of the UM department under the direct supervision of the Director of UM and Clinical Coordinator of Concurrent Review * Review and coordinate the clinical information for concurrent reviews, extending the length of stay for inpatients as appropriate. * Monitors admission and concurrent reviews to ensure the patient is receiving the appropriate care in a timely and cost-effective manner. Ensure retrospective reviews after treatment have been completed. * Calculates the length of stay and continued stay days for the patients. Documents outliers and/or risks to RCM. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Consults with physicians and other professionals to develop improved utilization of effective and appropriate services. * Will serve as the liaison between the admission, Pre-registration and UR department. * Ensure all requirements to secure prior-approval as identified and communicated appropriately. * Coordinates, tracks, document all authorization electronically and manage oral written communication related to authorization activity as appropriate. * Among the expectations of this role, the UR coordinator will have:

  • Experience with prior authorization in healthcare, behavioral health setting preferable
  • Denials and Appeals management experience
  • Inter-departmental understanding of MHO/BHO medical necessity criteria
  • ASAM and Medical necessity knowledge a MUST
  • Excellent organization skills
  • Excellent verbal, oral and written communication
  • Inter-departmental knowledge and use of EMR and RCM platforms
  • Participation in Interdisciplinary Team Meetings for continued efficiency and collaboration at the assigned locations

COMPETENCIES:

  • Displays documentation and record-keeping expertise
  • Effectively multi-tasks and completes assignments with consistent accuracy and timeliness.
  • Shows attention to detail in all job responsibilities
  • Works consistently with a sense of urgency
  • Shows advanced computer skills in work completion to include report preparation
  • Self identifies and pursues appropriate developmental opportunities

EMPLOYEE UNDERSTANDING:

  • The Utilization Review Coordinator is a full-time position working the hours required to meet job expectations.
  • Scheduled and unscheduled performance reviews are given according to company policies.
  • Limited travel may be required.
  • Employment with RiverMend Health is “at will” and employment may be terminated at any time with or without cause or notice.

EEO/DFW

Job Type: Full-time

Experience:

  • EOB's, Authorizations, Denials: 3 years (Required)
  • Utilization Review/Hospital: 3 years (Required)

Education:

  • Bachelor's (Required)

Work authorization:

  • United States (Required)

Benefits:

  • Health insurance
  • Dental insurance
  • Vision insurance
  • Retirement plan
  • Paid time off

Relocation Assistance Provided:

  • No