Utilization Review Tech

Prime Healthcare•Lynwood, CA

5d•Onsite

About The Position

St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the hospital for high quality and compassionate medical care. St. Francis is recognized for its full range of diagnostic and treatment services in specialties including Cardiovascular, Surgical, Orthopedics, Obstetrics, Pediatrics, Behavioral Health, and Emergency and Trauma Care. In addition, the hospital offers a broad array of education and outreach programs that advance community health. St. Francis Medical Center is a Comprehensive Stroke Center, STEMI Receiving Center, ED Approved for Pediatrics, Geriatric ED, Level III Neonatal ICU, and Level II Trauma Center. Please visit www.stfrancismedicalcenter.com for more information. Join an award-winning team of dedicated professionals committed to compassion, quality, and service!

Requirements

High School Diploma or equivalent required.
Accurate alphabetic, numeric, and/or terminal-digit filing skills.
Computer data entry with 10-key, with accurate typing speed of 35 wpm required.

Nice To Haves

Minimum one year denials management experience in acute care setting highly preferred.
Excel skills highly preferred.
Knowledge of terminal digit filing and medical terminology; preferred.
Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.
Completion of a medical terminology course; preferred.
Background in business and office training; preferred.

Responsibilities

Coordinate the utilization review and appeals process as part of the denial management initiatives.
Coordinate phone calls, data entry and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals.
Document and track all communication attempts with insurance providers and health plans.
Follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers.
Serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned.
Support the department needs for Release of Information, discharge coordination or other duties as assigned.