at NorthShore University Health System in Warrenville, Illinois, United States
Job Description
Position Highlights:
Position: Utilization Management Assistant
Location: Warrenville,
Part Time - 28 hours/week
Hours: 7am-1p; Tues: 7am-12:30 (flexible start time)
A Brief Overview:
Supports the UM Coordinators, Utilization Review by assisting with the workflow which includes conducting inpatient or outpatient precerts and discharge reviews, preparing appeals and completing insurance follow up calls on status of authorization requests.
What you will do:
Demonstrates the knowledge and skills necessary to provide care appropriate to the age of patients served.
This includes knowledge of the physical and psychological needs of patients served and the ability to respond appropriately to those needs.
Understands where to locate information, if needed to present case specific information, by means of the chart or clinic documentation.
Completes discharge reviews.
Checks charges, attendance functionality , and notes to check outpatient days attended. Sends missing charge emails to Billing Specialist as necessary.
Supports ancillary details of authorizations by completing authorization by any means necessary (live/telephonic, chart support, fax or portal).
Identifies new cases to be added to the Financial Appeals Log.
Adds cases identified from paperwork and/or Utilization Review Coordinators to Clinical Appeals Log for tracking purposes.
Assist in coordinating appeal efforts prior to patient's discharge.
Supports identifying integral denial/appeal/approval paperwork to identify for scanning purposes or distribution or charting purposes.
Reviews the Appeals Log for inpatient/partial hospitalization program/intensive outpatient program cases and read through the clinical documentation for the patient case. Writes letter to insurance organization requesting reconsideration for their denial of services.
May participate in contributing with any needed pieces for recredentialing applications or contracts.
Updates Appeals Log statistics.
Prepares data for the UM Committee meeting minutes as needed.
Makes follow-up phone calls to insurance companies on status of pending appeals.
Coordinates with Business Office and UM Coordinators regarding benefit issues/questions as needed.
Coordinates with Billing & Collection Specialist for quarterly reporting presentations and adds UM appeals statistics to presentation.
What you will need:
Non RN- Bachelors Degree Required
Proficiency in Microsoft Office products
Familiarity with behavioral health field, terminology and levels of care
Knowledge of DSM IVR (Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteria
Benefits:
Career Pathways to Promote Professional Growth and Development
Various Medical, Dental, and Vision options
Tuition Reimbursement
Free Parking at designated locations
Wellness Program Savings Plan
Health Savings Account Options
Retirement Options with Company Match
Paid Time Off and Holiday Pay
Community Involvement Opportunities
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
