We are looking for Utilization Review Assistant for our client in Rancho Mirage, CA
Job Title: Utilization Review Assistant
Job Location: Rancho Mirage, CA
Job Type: Contract - 12 Months / Contract to Hire / Direct Hire
- The Utilization Review Assistant is responsible for coordinating the administrative aspects of the utilization review process in order to ensure appropriate authorizations are obtained and the hospital is being paid for services provided.
- Demonstrates compliance with code of conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
- Faxes reviews, logs review requests, and refers telephonic review requests to appropriate Service Line Case Manager.
- Receives and communicates information regarding insurance and admit date changes from Financial Counselors to Case Managers.
- Tracks insurance reviews and obtains medical records for retro-review process. Educates staff on processes for communicating review needs and related requests.
- Notifies UM Specialist of payor denial sand assists with denial / appeal process as directed; attends Denial Committee meetings.
- Review daily admissions and discharges to determine reviews / authorizations requiring processing including requesting and obtaining medical records for retrospective reviews. Tracks, documents, and faxes utilization reviews to appropriate insurance /review agencies.
- Calls insurance agencies for final inpatient verification; enters information into Midas and notifies Business Office staff of problematic inpatient authorizations. Organize, copies, and distributes morning reports.
- Perform duties related to the Medi-Cal TAR process: Looks up mew Medi-Cal admissions and discharges daily, initiates TARS, logs new TARs in checklist, distributes TARs to Service Line Manager ; initiates retro ? TARs as initiated by Business office. Requests medical records for onsite MediCal representative and for retro review. Assist with MediCal bed searches.
- Retrieves and communicates voicemail messages from review agencies.
- Prepares and faxes ?Bad Notice? t physicians when requested by Nursing Administration, VP Clinical Resource Management, Case Management / Social Services or designee. Maintains patient confidentiality.
- Determines workload priorities and is able to complete a typical day?s assigned workload within the scheduled shift.
- Assures maintenance of department equipment and educates staff on equipment usage.
- Assists all members of the department by retrieving information from files and computer, making photocopies, mailing projects, and running errands.
- Types correspondence, reports, forms and other documents as requested.
- The position reports to the Case Management Director.
- Performs other duties as assigned.
Medical Terminology required:
- 1year recent general office / secretarial experiencerequired
- Prior experience with payor authorizations processes preferred