Assistant, Utilization Review
City/State: Fredericksburg, Virginia
Category: Support Services
Position Hours: 40Apply
Position Shift: Day (United States of America)
Job Requisition Number: R-3161
Job Department: 1007202 MWHC-Executive Office
Job Posted Date: May 03, 2021
Start the day excited to make a difference…end the day knowing you did. Come join our team.Job Summary:
This position is accountable to perform clerical and administrative support duties related to the effective operation of the department. This position must demonstrate a commitment of quality service to patients, co-workers, and physicians.
Essential Duties and Responsibilities:
- Provides and reconciles the clinical updates sent to insurance companies and governmental agencies.
- Responds to inquiries received from insurance co/governmental agencies regarding cases and determines which inquiries to obtain the Case Manager's input.
- Provides direct support for Medicare appeals per process.
- Enters authorization numbers in EPIC and closes those cases.
- Monitors data and notes trends with regards to payor responses and escalate concerns to Manager.
- Collects and checks for insurance logs daily call or fax to insurance companies as requested.
- Assesses and documents payor responses, e.g., days approved, next review date, denials, etc.
- Communicates messages retrieved via departmental phone or fax to other members of the healthcare team and follows up as needed.
- Support denials and appeals process by identifying cases in need of review, appeal or peer to peer and follow up with all parties involved.
- Other duties as assigned.
- High school graduate or equivalent.
- At least three years of recent administrative experience
- Typing speed of 50 wpm.
- Able to work in a team-oriented environment with ability to carry out assigned job duties, and exhibits flexibility in response to unexpected changes in work volume, emergency staffing and scheduling.
- Demonstrates ability to multi-task and exhibits strong time management skills.
- Proficient interpersonal, writing, and other communication skills necessary.
- Previous experience with Microsoft Office, Lotus Notes, personal computer knowledge including, but not limited to, word processing, spread sheets, electronic calendars, database management, graphics, presentations, and Internet communications.
- Bachelor’s degree
As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.