Utilization Management Assistant

San Juan Regional Medical Center•Farmington, NM

About The Position

The Utilization Management Assistant provides excellent service and a positive experience for each customer while serving as a liaison between the Utilization Management Team and payors. The role supports authorizations, denial and appeal documentation, tracking and monitoring concurrent and retrospective denials, and coordination of peer-to-peer conversations for denial mitigation. The assistant is expected to demonstrate San Juan Regional Medical Center’s values and Service Standards in their work.

Requirements

High school diploma or equivalent.
Five years of experience in healthcare and/or insurance.
Strong communication skills.
Excellent customer service skills and phone etiquette.
Ability to function autonomously.
Experience with computer programs, including Excel and Office.
Ability to set and maintain priorities while handling multiple demands and interruptions.
Knowledge of insurance and billing requirements.

Nice To Haves

Medical terminology.
Utilization Management experience.

Responsibilities

Receive clinical denials through phone calls, fax, and the EMR.
Document inpatient authorizations and payor communications.
Provide initial and concurrent clinical information to payors through the EMR and payor portals.
Maintain denial and appeal work queues for the Utilization Management team.
Review and compile denial and appeal documentation and submit it in a timely manner.
Track and monitor concurrent and retrospective denials.
Assist with coordination of peer-to-peer conversations for denial mitigation.
Coordinate W2 meetings and complete provider correspondence.
Communicate effectively.
Perform related duties and responsibilities as required, including other duties as assigned.
Implement SJRMC Service Standards—Safety, Courtesy, Effectiveness, and Stewardship—in work activities.