Utilization Review Associate - Hampstead Hospital
Utilization Review Associate - Hampstead Hospital
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
Receives documents investigates refers and coordinates grievances and appeals. Initiates case files for each grievance and ensures compliance with organizational and regulatory requirements. A significant portion of the day will be devoted to clerical functions related to medical records in various locations in the hospital. This role is ONSITE at Hampstead Hospital.
Responsibilities
- Assists others in the appeals process. Communicates to insurers. Documents activity and provides information upon request.
- Maintains ongoing monitoring of Denial Management system and takes action based on status of denial. Enters all paper denials into the Denial System.
- Coordinates with Revenue Management and Patient Access staff around medical necessity denials that may overlap between the various departments.
- Visits Medicare patients and Medicare Advantage patients daily. Communicates Medicare Important Notices of Patient Discharge Rights.
- Orders medical records and faxes clinical information to insurers.
- Collaborates with outside contracted agencies performing appeals.
- Develops and provides reports to demonstrate outcomes of denials work and effectiveness of appeal process.
- Manages all incoming mail and correspondence to the Appeals office.
- Reviews and confirms monthly status reports.
- Collects and coordinates data collection to provide data base reports regarding patient notices delivered.
- Communicates with appropriate insurance company contact to provide necessary information to avoid a denial.
- Performs other duties as required or assigned.
Qualifications
- Associates degree with 1 year of secretarial or administrative assistant experience in a medical setting required.
- Extensive experience with word processing spreadsheets and data processing required.
- The ability to function effectively and independently in a fast paced environment.
- Excellent interpersonal and communication skills required.
Required Licensure/Certifications
- None
Required Experience:
IC
Employment Type
Full-Time
