Utilization Management Assistant

Location:

Work from home (Pennsylvania)

Shift:

Days (United States of America)

Scheduled Weekly Hours:

40

Worker Type:

Regular

Exemption Status:

No

Job Summary:

​In this role, you will support the staff in their day-to-day responsibilities. Ensures clerical activities provide efficiency and organization to the department. Performs duties and tasks in accordance with performance standards established. Plays a key role in ensuring information is released to payers and physician level review. Frequently works with highly sensitive and confidential information.

Job Duties:

• Performs office functions to include but not limited to; answers and triages phone calls, facilitates/assists with calls to insurance companies, maintains and orders supplies and office equipment, collects and verifies information from source documents, either paper or electronic.
• Serves as a resource to departmental staff regarding insurance contacts.
• Maintains Utilization management SharePoint site to reflect updated payor information.
• Demonstrates competency in accessing and documentation in hospital computer systems and programs.
• Ensures timely notification of admission and discharge in accordance to payor standards.
• Works in conjunction with the Utilization nurses to ensure timely transfer of information to payers to ensure timely and accurate documentation of authorizations, denials, peer to peer status, physician advisor communication prior to discharge.
• Performs Release of Information for respective organizations.
• Communicates all progress, completion or problems on each patient to Utilization Management nurses throughout the work day.
• Identifies and notifies appropriate staff regarding discrepancy issues with third party payer health insurance coverage and lack of coverage.
• Serves as a subject matter expert regarding various insurance portals.
• Exhibits competency and accurate completion for new users and employee alterations.
• Accurate completion and maintenance of Utilization Management Assistant (UMA) work queue upon conclusion of work day.
• Ensure right faxes are complete by conclusion of your assigned day of work.
• Identify and complete mother and baby birth outcomes.
• Develops and maintains positive relationships between physicians and office staff.
• Interacts with physicians as needed.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Position Details: