Resource Specialist I
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Job Location:
Somerville, NJ - USA
Hourly Salary:
$ 19 - 27
Posted on:
6 days ago
Vacancies:
1 Vacancy
Job Summary
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Reporting to Manager for Utilization Management the Utilization Management Resource Specialist (UMRS) works collaboratively with the Utilization Management Case Managers (UMCM) Clinical Operations Revenue Cycle Operations and the Physicians Advisors providing direct administrative support to the utilization review processes and to the department. The UMRS must have strong communication skills and the ability to converse comfortably with internal and external customers. The position requires a high degree of flexibility independence and willingness to participate in multiple activities and provide support to all members of the MGB team.
Job Summary
Primary ResponsibilitiesWork collaboratively with MGB Utilization Management to support an efficient cost effective and compliant utilization plan and care needs along the continuum. This may include but is not limited to:
Provides direct support to the utilization management case managers
Provides reports to internal and external customers
Conducts daily data collection per direction of UM leadership.
Checks UR line for voicemails
Faxes/emails communications to internal and external customers
Manages email communication from payors by entering requests into the payor request folder entering
requests into the peer to peer folder forwarding payor emails to appropriate CM staff.
Enters approved LOS from payors in EPIC
Enters denials in the retro folder and documents the denial in auth cert.
Works collaboratively with Admitting ensuring the patient has correct insurance entered and appropriate prior authorization.
Manages all incoming faxes/emails
Scans mail memos and other documents and enters approvals in EPIC
Assists in escalating payor authorizations for patients going to rehab
Updates payor dictionaries
Qualifications
What Youll Bring
Requirements:
- High School Diploma
Preferences:
- Associates Degree
- 2 years related experience (medical terminology Electronic Medical Records (EMR) hospital utilization management or case management prior authorization etc.)
Additional Knowledge Skills and Abilities:
- Familiarity with community services/resources.
- Ability to maintain effective working relationships with patients/families.
- Strong assessment and crisis intervention.
- Excellent interpersonal skills.
- Excellent collaboration customer service and advocacy skills.
- Excellent written and verbal communication skills.
Additional Job Details (if applicable)
Schedule and Work Model
- Full-time (40 hours) Monday through Friday standard business hours.
- Remote / Work from Home. Employees must use a stable secure and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$19.42 - $27.74/HourlyGrade
3EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
IC
Key Skills
- Employee Relations
- Typing
- Succession Planning
- Human Resources Management
- Military Experience
- Case Management
- Benefits Administration
- HRIS
- Payroll
- ADP
- Human Resources
- Leadership Experience
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
