Utilization Management Insurance Liaison - Hybrid opportunity

UR Thompson Health•Canandaigua, NY

36d•Hybrid

About The Position

Join our growing and well respected community health system and enjoy competitive pay, high patient and staff satisfaction levels, excellent infection control support and compliance, free parking, tuition assistance and other excellent benefits! The Utilization Management Insurance Liaison is responsible for managing the submission of clinical documentation to insurance companies for hospital admissions. This position tracks insurance approvals and denials, coordinates appeals and peer to peer discussions between the hospital providers and the insurance companies. This role ensures compliance with CMS regulations, NYS regulations and insurance company policies. This position acts as liaison to the business office and other hospital departments. The Insurance Liaison supports the Utilization Management team by completing administrative tasks and assisting with coverage of select tasks when other members of the team are on vacation or leave.

Requirements

Demonstrates understanding of state and federal regulations as pertains to Utilization Review and demonstrates familiarity with payer-specific guidelines
Demonstrates ability to work independently as well as part of team
Demonstrates the ability to develop and maintain collaborative working relationships with associates, leaders, medical staff and outside agencies
Exhibits flexibility in decision-making and prioritizes workload responsibilities
Demonstrates strong problem-solving, attention to detail and organizational skills
Demonstrates interpersonal skills, professional manner and excellent communication
High standard of medical & business ethics
Actively guards the confidentiality of sensitive information including but not limited to the patients, staff, and the health system
Demonstrates time-management skills with the ability to multi-task and meet deadlines
Demonstrates ability to use many software products including EHRs, Microsoft products, and other software/programs to assist with data analysis
Demonstrates comprehensive knowledge of insurance plans, member eligibility, medical billing with understanding of CPT, ICD-10 and medical terminology
High School Graduate or equivalent required
1-3 years’ experience in a healthcare environment required
Strong computer, communication & organizational skills

Nice To Haves

Associate or Bachelor’s degree preferred
Previous experience reviewing and analyzing denials, claims and rejections preferred
Previous experience with reimbursement systems, DRGs/APCs, medical billing CPT codes, ICD10 coding guidelines preferred

Responsibilities

managing the submission of clinical documentation to insurance companies for hospital admissions
tracks insurance approvals and denials
coordinates appeals and peer to peer discussions between the hospital providers and the insurance companies
ensures compliance with CMS regulations, NYS regulations and insurance company policies
acts as liaison to the business office and other hospital departments
supports the Utilization Management team by completing administrative tasks and assisting with coverage of select tasks when other members of the team are on vacation or leave