Utilization Review Specialist I - FT - Day - Utilization Resource Management Pennington NJ

Benefits

Additional Information

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Pay Range: $20.50 - $26.64 Scheduled Weekly Hours: 40 Position Overview Works as member of multidisciplinary team to provide support for utilization and denial process. Performs follow-up tasks identified by Utilization and Denial team to enhance management of cases and department's processes. Supports Utilization Review department and various revenue cycle department operations and assists with task to promote positive, timely, cost-effective outcomes. MINIMUM REQUIREMENTS Education: High school diploma or GED. Experience: Two years related office experience. Acute healthcare setting preferred. Other Credentials: Knowledge and Skills: Knowledge of Word, Excel, and PowerPoint. Must be able to work independently and possess excellent verbal and written communication skills. Utilization Review Specialist I must have ability to function as a team member and appropriately seek supervision as needed. Special Training: Mental, Behavioral and Emotional Abilities: Demonstrates ability to organize and prioritize responsibilities and has ability to interact with all levels of staff in a courteous and professional manner. Must be willing and able to travel between campuses. Usual Work Day: 8 Hours Reporting Relationships Does this position formally supervise employees? No If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager. ESSENTIAL FUNCTIONS Collaborates with Utilization nurses by preparing Medicare MOON forms for patients and assures accuracy of the form. Issue Medicare MOON form to patients and communicates Medicare Rights to patients and family members when applicable. Coordinates timely and accurate receipt, processing, production, and distribution of regular reports to appropriate department staff. Enters all denial information received through mail or other correspondence in appropriate area in EMR system timely and accurately. Maintains accurate records of all denial and appeal activity by following the department workflow for the handling of denials and appeals. Refers all denial and appeal correspondence to appropriate parties for review and response. Follows up for completion and maintains statistics on denial and appeal activity. Monitors and reports on daily Observation and Outpatient in a bed census. Organizes and maintains department files and paperwork and ensures that all materials are filed accurately and in a timely manner. Maintains confidentiality of information. Assists with special programs including data collection for process improvement projects. Uploads appeal letters and appeal responses and monitors timeliness of appeals. Assists nurses with Utilization Management incompletes by using payer portals to obtain determinations and insurance responses. Monitors timelines of appeals. Uploads all correspondences received for insurance carriers into EMR Coordinates all office activities such as maintaining accurate electronic filing systems, opening and distributing mail, preparing and distributing correspondence, creating daily reports Performs other duties as assigned. PHYSICAL DEMANDS AND WORK ENVIRONMENT Frequent physical demands include: Sitting , Standing , Keyboard use/repetitive motion , Talk or Hear Occasional physical demands include: Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor activities Continuous physical demands include: Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs. Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing Anticipated Occupational Exposure Risks Include the following: Bloodborne Pathogens , Chemical , Airborne Communicable Disease This position is eligible for the following benefits: Medical Plan Prescript