Summary
SUMMARY:Supports our Utilization Management Team for all inpatient facilities enhancing operational efficiency and patient care coordination. Key responsibilities include reconciling patient census data, providing administrative assistance, facilitating discharge planning, liaising with payors, and ensuring precise data entry and reporting. This role demands accuracy and the ability to manage multiple tasks effectively, supporting both clinical and administrative functions within the department.
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Communicates status with Utilization Management staff and arranges for patient transfer;functions as a key point of contact between Utilization Management staff, admissions and payers.
Coordinate and track any communication, e.g. Important Message (IM) letters, Denial Letters, patient choice forms; regularly updates Utilization Management team.
Coordinates and obtains authorizations for admissions; documents all information in the AHS financial system; works closely with Revenue Cycle to ensure each inpatient encounter is accurate; coordinates all reviews and inquires with the payors.
Coordinates with referral sources on bed availability, new product and services; maintains current database of existing and potential referral sources.
Functions as a key point of contact between clinical Utilization management staff, admissions and payors. Documents all interactions with payors and communicates status with Utilization Management staff.
Perform all other duties as assigned.
Reconciles census; works with Patient Access and the Utilization Management team toensure census is correct in the financial and Utilization management systems; prepares paperwork and updates encounter information for admissions, discharges and transfers of patients; prepares census for the Utilization Management staff.
Supports any audits with coordinating medical records with HIM; prepares statementsof diagnosis and treatments, and extracts other information required for the completion of forms received from patients’ insurance carriers.
MINIMUM QUALIFICATIONS:
Preferred Education: Bachelor’s degree in related field.
Preferred Experience: Medical Assistant.
Required Education: High school diploma or G.E.D.
Required Experience: Three years in a health Case field or one year in Utilization Management or Case Management at a Medical Group, Acute Care Environment or Health plan experience; electronic Health Record (EHR) and Utilization Management applications, e.g. EPIC, Midas or 3M.
