Utilization Review & Reimbursement Specialist

We have the great privilege of helping patients and families re-build their lives. Its extraordinarily meaningful work and the reason we greet the day with optimism and anticipation. When patients Ask for Mary they experience a culture that has been sculpted for more than a century. Our hallmark is to carefully listen to patients and innovatively serve them. This is true of every employee from support staff and leadership to clinicians and care providers.

Mary Free Bed is a not-for-profit nationally accredited rehabilitation hospital serving thousands of children and adults each year through inpatient outpatient sub-acute rehabilitation orthotics and prosthetics and home and community programs. With the most comprehensive rehabilitation services in Michigan and an exclusive focus on rehabilitation Mary Free Bed physicians nurses and therapists help our patients achieve outstanding clinical growing Mary Free Bed Network provides patients throughout the state with access to our unique standard of care

Mission Statement

Restoring hope and freedom through rehabilitation.

Employment Value Proposition

At Mary Free Bed we take pride in our values-based culture:

• Focus on Patient Care. A selfless drive to serve and heal connects all MFB employees.
• Clinical Variety and Challenge. An inter-disciplinary approach and a top team of professionals create ever-changing opportunities and activities.
• Family Culture. We offer the stability of a large organization while nurturing the family/team atmosphere of a small organization.
• Trust in Each Other. Each employee knows that co-workers can be trusted to make the right decision for our family patients staff and community.
• A Proud Tradition. Years of dedicated quality service to our patients and community have yielded a reputation that fills our employees with pride.

SummaryResponsible for coordinating the Medical Record/Utilization Management Policies and Procedures according to standards set by the Hospital Mary Free Bed Medical Staff and outside regulatory includes the analysis of medical records for documentation justifying the need for post-acute care services. This position works across the Mary Free Bed network of hospitals to provide insurance authorization services and extended stay reviews and recommendations to provide access to inpatient rehabilitation when appropriate. The Utilization Review/Reimbursement Specialist is responsible for driving denial management strategies to ensure all appropriate patients have access to Mary Free Bed inpatient programs.

Essential Job Responsibilities

• Coordinates utilization management review functions as set forth in the Hospital Utilization Review Plan (screening for determination of necessity eligibility and appropriateness) at preadmission admission continued stay and discharge.
• Analyzes insurance governmental and accrediting agency standards to determine criteria concerning admissions treatment and length of stay of patients.
• Manages the completion of prior authorization/recertification calls or faxes to a variety of third-party insurers as a part of the reimbursement process.
• Complex case reviews for determination of inpatient admission criteria.
• Implements strategies to navigate insurance authorization process efficiently.
• Responsible for robust data capture through documentation of denial management activities and outcomes.
• Assists manager in the following areas:
• Departmental and hospital-wide educational activities.
• Review and refinement of Utilization Review policies and procedures.
• Medical chart review and composition of insurance appeal letters on behalf of patients.
• Develops and maintains relationships with key payers to improve access to inpatient services at Mary Free Bed.
• Admission office duties as assigned by the supervisor
• Well embrace all people by:

Treating everyone with dignity and respect.

Opening more doors to opportunity for others to succeed.

Growing talent and people.

Ensuring a welcoming experience for all we serve regardless of origin race religion disability sexual orientation or socioeconomic status.

Taking action against discrimination.

Honoring our differences and how we collaborate.

Educating staff patients and the communities we care for.

Restoring hope and freedom together

Customer Service Responsibilities

Demonstrate excellent customer service and standards of behaviors as well as encourages coaches and monitors the same in team members. This individual should consistently promote teamwork and direct communication with co-workers and deal discretely and sensitively with confidential information.

Responsibilities in Quality Improvement

Contribute by identifying problems and seeking solutions. Promote patient/family satisfaction where possible; participates in departmental efforts to monitor and report customer service.

Essential Job Qualifications

• Degree in nursing social work physical therapy occupational therapy speech therapy athletic trainer or equivalent degree.
• Valid drivers license with no restrictions
• Demonstrated competence in spelling grammar and composition and able to type accurately.
• Ability to interact with professional staff in an appropriate manner.
• Demonstrated competence in the use of a personal computer for development and use of appropriate Medical Records Admissions and Utilization Management applications.

Preferred Job Qualifications

• A minimum of 2 years experience in Utilization Management
• Certification as a Registered Health Information Technician or Registered Health Information Administrator a plus

Physical Requirements for Essential Job Qualification

Levels:

• None (No specific requirements)
• Occasionally (Less than 1/3)
• Frequently (1/3 to 2/3)
• Majority (More than 2/3)

Remain in a stationary position: Majority

Traverse or move around work location: Occasionally

Use keyboard: Frequently

Operate or use department specific equipment: None

Ascend/Descend equipment or ladder: None

Position self to accomplish the Essential Functions of the role: None

Receive and communicate information and ideas for understanding: None

Transport position and/or exert force:

Up to 10 pounds: Occasionally

Up to 25 pounds:

Up to 50 pounds:

Up to 75 pounds:

More than 100 pounds:

Other weight: Up to pounds

Other: None

Consistent with the Americans with Disabilities Act (ADA) it is the policy of Mary Free Bed Rehabilitation Hospital to provide reasonable accommodation when requested by a qualified applicant or employee with a disability unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment including the application process. If reasonable accommodation is needed please contact the Talent Acquisition team at .

Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion gender national origin age genetic information veteran status disability or other legally protected characteristic.