Utilization and Appeals Data Assistant

Catholic Health•Melville, NY

2d•$24 - $30

About The Position

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! The CH Utilization and Appeals Data Assistant provides support to the CH Utilization and Appeals Department. The Data Assistant works closely with the Director of Physician Advisors to assist with worklists and scheduling of Peer to Peers. The Data Assistant may also assist with database management including entry of denial correspondence, timely requests for medical records and utilization and appeal follow-up.

Requirements

High School Diploma or equivalent
2 years college preferred.
Sound knowledge and skill in the use of personal computer and software for word processing and spreadsheet required. Experience with EPIC, Midas and other hospital software as required.
Ability to effectively communicate with all levels of hospital staff in a verbal and written manner; demonstrated ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.
Demonstrates a courteous and professional demeanor, team spirit and the ability to work in a collaborative, effective manner.
Ability to utilize critical thinking and apply sound clinical judgment and assessment skills for decision making.
Maintains knowledge of requirements by third party payers, regulatory agencies, and managed care entities concerning levels of care, continuity of benefits and medical necessity guidelines.
Knowledge of managed care and the current standards and trends of patient care, best practices, management tools.

Responsibilities

Manages physician advisor reports and assists with facilitating UM Committee reviews when applicable.
Assists with and reconciles the case status on the PA list
Submits and tracks R1 cases via the portal
Assists with assignment of peer-to-peers
Coordinates Peer-to-Peer meetings between physicians and payors.
Notifies Department Leadership of potential missed timeframes for submission and follow-up on responses and escalates cases as appropriate.
Coordinates physician schedules
Assists with UM/Appeals as needed
Provides support for ongoing projects as required
Meets productivity standards.
Attends meetings as required and participates on committees as directed.
Performs other related duties as assigned or requested.