HOW WE CARE FOR YOU:
At Rochester Regional Health, we are dedicated to getting health care right. Our robust benefits and total rewards foster employee wellbeing, professional development and personal growth. We care for your career while caring for the community.
- Pension Plan
- Retirement Plan
- Comprehensive Benefits Package
- Tuition Reimbursement
- Benefits Effective Date of Hire
- Same Day Pay through Daily Pay
SUMMARY
Coordinate hospital based medical necessity denials for the health system. Responsibilities include managing the workflow with the standard UM sources for potential inpatient medical necessity denials. Act as a liaison for the health system and Executive Health Resources. Responsibilities include concurrent (as needed) and retrospective reviews. Responsibilities include function involved concurrent and retrospective reviews. The Utilization Management Coordinator will act as a resource on denial management as needed across the organization
STATUS: Full time
LOCATION: Riedman Campus
DEPARTMENT: Utilization Management - Physician Advisory Program
SCHEDULE: Monday - Friday days
ATTRIBUTES
- 3 years of Utilization Management experience preferred
- 3 years of acute hospital care, administrative assistance, and/or customer services
- Experience with Abstracting data denials and appeals and maintaining statistics
- Proficient in computer skills (Word, Excel, PowerPoint, etc.) ?
RESPONSIBILITIES
- Track and monitor all denials, appeals, arbitration responses to payers/audits
- Initiate an E HR 1st, 2nd, and/or arbitration appeals as needed. Document in all areas that an appeal has been initiated or no appeal is necessary per E HR reviews.
- Reconcile E HR inpatient medical necessity denials.
- Receive E HR determination letters and forward to Utilization Review Specialists and/or HIM.
- Review MVP authorization and morning list daily to determine if clinical update is needed, and/or patient was discharged.
- Answering the UM, LOC, and E HR phone lines. Facilitates and responsible for clinical to be e-faxed by the Utilization Review Specialists to support inpatient admission.
- E-fax clinical to the payer per their request to as needed. Retrieve all corresponds from the mail room and sort and track as needed. ?
PHYSICAL REQUIREMENTS: S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
PAY RANGE: $21.50 - $31.60