Utilization Management Clinical Assistant - Corporate Center Warrenville

Nevada System of Higher Education•Warrenville, IL

9d•$22 - $33•Onsite

About The Position

Supports the Coordinator, Utilization Review by assisting with the workflow which includes conducting precerts and discharge reviews, preparing appeals and completing insurance follow up calls on status.

Requirements

Bachelors Degree Required
Proficiency in Microsoft Office products
Familiarity with behavioral health field, terminology and levels of care
Knowledge of DSM IVR (Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteria

Responsibilities

Demonstrates the knowledge and skills necessary to provide care appropriate to the age of patients served. T his includes knowledge of the physical and psychological needs of patients served and the ability to respond appropriately to those needs.
Understands where to locate information, if needed to present case specific information, by means of the chart or clinic documentation.
Completes discharge reviews.
Checks charges, attendance functionality , and notes to check outpatient days attended.
Sends missing charge emails to Billing Specialist as necessary.
Supports ancillary details of authorizations by completing authorization by any means necessary (live/telephonic, chart support, fax or portal).
Identifies new cases to be added to the Financial Appeals Log.
Adds cases identified from paperwork and/or Utilization Review Coordinators to Clinical Appeals Log for tracking purposes.
Assist in coordinating appeal efforts prior to patient’s discharge.
Supports identifying integral denial/appeal/approval paperwork to identify for scanning purposes or distribution or charting purposes.
Reviews the Appeals Log for inpatient/partial hospitalization program/intensive outpatient program cases and read through the clinical documentation for the patient case.
Writes letter to insurance organization requesting reconsideration for their denial of services.
May participate in contributing with any needed pieces for recredentialing applications or contracts.
Updates Appeals Log statistics.
Prepares data for the UM Committee meeting minutes as needed.
Makes follow-up phone calls to insurance companies on status of pending appeals.
Coordinates with Business Office and Coordinators, Utilization Management regarding benefit issues/questions as needed.
Coordinates with Billing & Collection Specialist for quarterly reporting presentations and adds UM appeals statistics to presentation.