Company Overview
Riveredge Hospital is a dedicated behavioral healthcare facility serving children, adolescents, young adults, and adults in the Chicago area. Our interdisciplinary team of professionals is committed to providing compassionate, high-quality mental health services in a supportive environment.
Overview
We are seeking a detail-oriented and proactive Utilization Management Coordinator to join our team. This vital role involves coordinating the review and approval of patient care services, ensuring compliance with healthcare policies, and facilitating effective communication between clinical staff, insurance providers, and patients. The ideal candidate will possess strong medical office experience, knowledge of health insurance policies, and familiarity with medical coding and electronic health records management.
Duties
- Review and evaluate medical records and clinical documentation to determine medical necessity for services using established criteria such as CPT (Current Procedural Terminology), ICD-9, and ICD-10 codes.
- Coordinate with healthcare providers to obtain additional information or clarification needed for utilization review processes.
- Ensure all documentation complies with HIPAA (Health Insurance Portability and Accountability Act) regulations to maintain patient confidentiality and privacy.
- Verify insurance coverage, benefits, and authorization requirements for various health plans, including managed care organizations.
- Maintain accurate electronic health records (EHR) by documenting review outcomes, correspondence, and authorization statuses efficiently within the system.
- Collaborate with clinical teams to facilitate timely approvals for patient care plans while adhering to clinical confidentiality policies.
- Stay current on evolving health insurance policies, coding updates, and regulatory requirements affecting utilization management procedures.
Skills
- Proven experience working in a medical office environment or healthcare setting with a focus on utilization review or case coordination.
- Strong understanding of HIPAA regulations and the importance of maintaining strict confidentiality of medical records.
- Proficiency in CPT coding, ICD-9/ICD-10 coding systems, and ICD coding standards for accurate documentation.
- Knowledge of managed care processes, health insurance policies, and insurance verification procedures.
- Experience with electronic health record (EHR) or electronic medical record (EMR) systems for documentation management.
- Familiarity with medical terminology and clinical confidentiality policies essential for effective communication within healthcare teams.
- Ability to multitask efficiently in a fast-paced environment while maintaining attention to detail.
Requirements:
- Must have a Bachelor’s degree, Master’s degree preferred.
- Must have an appropriate background in the mental health field to organize and achieve quality performance with a focus on securing reimbursement for the organization.
- Possess an in depth knowledge of funding sources and government reimbursement protocols.
- A minimum of 2-3 years supervisory experience.
- Thoroughly understands the management of UM data obtained from admission, concurrent reviews and appeals utilizing the Severity of Illness/Intensity of Service Criteria.
- Has knowledge of JC, CMS, Illinois Mental Health Code Act, and all other relevant state and federal regulatory standards.
- Possesses strong verbal and written communication skills.
Join our dedicated team as a Utilization Management Coordinator and contribute to delivering efficient, compliant, and patient-centered behavioral healthcare services!
Pay: $30.00 - $46.00 per hour
Benefits:
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Work Location: In person
