Administrative Assistant - Full Time, Days (Culver City)

Southern California Hospital at Culver City • Culver City, CA

2d • $23 - $32

About The Position

Under the direction of the Director of Utilization Management, the Utilization Review Administrative Assistant directs all back-office functions of the Case Management Department. Interfaces with all payors/providers requesting authorizations, medical records, and other specific information. Confirms completeness of reviews to payors. Directs concurrent denials to appropriate local staff.

Requirements

• High School Diploma or GED equivalent
• Knowledge of utilization management
• 2 years works experience
• Must demonstrate customer service skills appropriate to the job
• Computer literacy and proficiency
• Excellent written and verbal communication skills
• Ability to establish and maintain effective working relationships within the organization
• Ability to multitask and maintain a work pace appropriate to workload

Nice To Haves

• N/A

Responsibilities

• Interfaces with all payors and providers requesting authorizations, medical records, and other specific information.
• Completes payor and provider request for missing or additional documentation.
• Logs all authorization requests to ensure that they are submitted the same day as requested.
• Forwards all managed care/payor questions, correspondences and authorizations to the Director of Utilization Management (or designee).
• Ensures that all requests are handled appropriately and in a timely manner.
• Performs basic reception functions to ensure smooth office operations, including answering incoming calls, maintaining an accurate filing system, ensuring office supplies stocked to appropriate levels and office equipment serviced, copying forms and documents, etc.
• Types memos and other Utilization management documents as assigned.
• Effectively uses computer programs.
• Accurately collects and documents all necessary and required information and activities into the appropriate computer systems.
• Interfaces with outside agencies and payor services.
• Processes treatment authorization requests and forward to the Department of Mental Health IBHIS system.
• Completes admissions, discharge, TAR submissions and uploads documentation for daily review.
• Ensures that all patient privacy guidelines/laws are followed.
• Maintains audits for timely completion of Utilization Reviews.
• Completes audits for retroactive reviews and provides same day summary to Director of Case Management.
• Ensures that all reviews are completed and received by the payor in a timely manner.
• Maintains status and oversees required performance improvement data/documents for current PI/Quality indicators.
• Cross references multiple sources of data, ensuring that information is appropriately placed in patient’s medical records.
• Accurately collects data under the direction of the Leader of the Department and/or UR Committee members.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED