Utilization Review Coordinator

PruittHealth • Norcross, GA

1d

About The Position

The Care Integration Utilization Review Coordinator gathers, reviews, and tracks documents associated with clinical documentation requests. The coordinator maintains information about these requests and coordinates timely responses and outcomes. The role requires working under time pressures and changing priorities, collaborating with a team with minimal supervision, maintaining regular attendance, and attending professional training as directed.

Requirements

• High school diploma or equivalent.
• At least 3 years of healthcare experience, preferably in a long-term care environment.
• Working knowledge of registration systems for patient documentation and billing.
• Knowledge of commercial insurance and case management criteria.
• Knowledge of industry payment and reimbursement methodologies and ADR processes.
• Understanding of state and federal regulations.
• Proficiency in MS Office Suite, including Excel, Visio, PowerPoint, Word, Outlook, and Skype.
• Keyboard proficiency.
• Problem-solving skills.
• Medical assessment and documentation skills.
• Excellent customer service and communication skills.
• Ability to maintain confidentiality regarding patient and company proprietary information.
• Ability to relate professionally and positively and work cooperatively with patients, families, and employees at all levels.

Nice To Haves

• One year of experience in medical insurance billing, medical accounts receivable, or similar medical business office work.
• Ability to work within the scope of job requirements.
• Ability to multitask and manage a consistent workflow.
• Ability to think critically and work independently.
• Ability to develop and foster relationships.
• Good listening skills.
• Initiative to follow up on pending issues and organize and assign work.
• Effective oral, written, and telephone skills.

Responsibilities

• Request and technically review medical documentation from skilled nursing facilities (SNFs).
• Assist SNFs with questions related to requests for medical documentation.
• Maintain and follow up on medical review audits with insurance payers and SNFs.
• Use a tracking system to maintain accurate records of documentation processed in the assigned area.
• Protect the confidentiality of protected health information and sensitive information concerning Care Management partners.
• Perform assigned duties under time pressures and changing priorities and deadlines.
• Work in a team environment with minimal supervision.
• Deliver exceptional customer service.
• Perform other related duties as required by the supervisor.
• Maintain timely, regular attendance.
• Attend professional training as directed.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED