Utilization Management Assistant

Franciscan Alliance•Greenwood, IN

5d•Hybrid

About The Position

The Utilization Management Assistant performs secretarial or clerical functions to support the administrative operations of the Utilization Management department. This position assists by reviewing and scanning prior authorization forms into the electronic medical record system, reviewing and working the high volume of faxes received daily from payers, reviewing surgery schedules, and requesting authorization for services.

Requirements

High School Diploma/GED required
1 year of clerical/office experience preferred
1 year of hospital experience preferred

Responsibilities

Obtain status details regarding care authorizations and supervisory visit requirements from insurance payers.
Follow payer processes (website, fax, contact number) to submit appropriate clinical documentation; remain current on updates from payers, to ensure appropriate reimbursement from payers.
Collect clinical information regarding services to be rendered for prior authorizations.
Contact payers to obtain prior authorizations; enters standardized documentation within electronic medical record, to identify prior authorization and the criteria surrounding each authorization.
Educate collaborative multi-disciplinary teams regarding the prior authorization process; advise providers and their clinical staff when issues arise relating to obtaining prior authorization.
Complete administrative duties which include answering telephone calls and directing them to the appropriate team member, if needed, reviewing incoming faxes, manually fax if system is down, provide support to the nurses on the team.
Process prior authorization forms.
Respect the sensitive nature of correspondence and consistently maintains confidentiality.
Assist in the onboarding and training of new coworkers, to ensure all coworkers receive consistent and accurate information.