Utilization Review Tech II - Social Work Services
Utilization Review Tech II - Social Work Services
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Salary Not Disclosed
1 Vacancy
Job Description
Overview
St. Marys General Hospital located in Passaic NJ is a communitybased tertiary medical center focused on providing quality compassionate care. It is an acute care hospital providing a broad range of services including cardiovascular services as well as a comprehensive program for cancer care. The hospital is also a center of excellence for maternalchild health and outpatient behavioral health services. It is the only hospital in Passaic and with over 550 physicians and 1000 employees and is one of the largest employers in the county. Every member of the St. Marys General team is committed to providing respectful personalized highquality care. St. Marys General Hospital is a member of Prime Healthcare which has been lauded as a Top 15 Healthcare System by Truven Health Analytics. For information visit .
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race color sex sexual orientation gender identity religion national origin age (subject to applicable law) disability military status genetic information or any other basis protected by applicable federal state or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls data entry and tracking data from various insurance providers and health plans regarding authorization expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC MAC CERT ADR Pre/Post Probes QIO/Medicaid) and other payer audits as assigned. The Utilization review tech will further support the department needs for Release of Information discharge coordination or other duties as assigned.
Qualifications
EDUCATION EXPERIENCE TRAINING
1. High School Diploma or equivalent required.
2. Associates degree or higher preferred.
3. Two years of relevant experience required
4. Accurate alphabetic numeric and/or terminaldigit filing skills.
5. Computer data entry with 10key with accurate typing speed of 35 wpm required. Excel skills highly preferred.
6. Knowledge of terminal digit filing and medical terminology; preferred.
7. Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.
8. Completion of a medical terminology course; preferred.
9. Background in business and office training; preferred.
Employment Type
Full-Time
