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Utilization Mgmt Rep
Company | Advocate Health Care |
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Location | Western Springs, IL, USA |
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Salary | $20.4 – $30.6 |
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Type | Full-Time |
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Degrees | Associate’s |
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Experience Level | Junior, Mid Level |
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Requirements
- High School Graduate or equivalent and 4+ years secretarial experience or Associates Degree
- 2+ years of secretarial experience – preferably in a medical environment
- Competent in advanced functions with Microsoft Outlook, Word, Power Point, Excel and complete basic reporting
- Type 55+ words per minute
- Strong critical thinking and communication skills to problem solve, and interact with colleagues, physician and payers
- Ability to foster and maintain effective professional relationships, manage conflict while demonstrating Advocate Aurora’s Behaviors of Excellence at all times
- Ability to be flexible and function well in a fast paced, continually changing environment
- Comply with strict adherence to predetermined procedures and processes, safety, compliance and privacy/HIPAA guidelines
Responsibilities
- Manage incoming fax, phone, and portal communications or any other requests from internal and external customers pertaining to clinical requests, approvals, authorizations, and denials; determine action required, and document all activities performed accurately and clearly in the designated database/area(s) of EHR
- Communicate clinical needs, authorizations, and denials to the Utilization Review Nurses and Managers for follow up
- Verify insurance information provided by callers, fax, or Portal and send information to payers as requested, including discharge dates and disposition or clinical reviews/summaries prepared by UM RNs (if directed to do), while ensuring that all actions taken align/comply with the confidentiality and HIPAA compliance guidelines
- Follow up with payers to validate the authorization and confirm the days approved, and capture approved days in the EHR
- Enter data into database, spreadsheets, and perform analysis as directed
- Provide efficient, courteous, and expert customer service to all internal and external callers
- Open, sort, and process incoming mail/correspondence directed to the Utilization Review
- Maintain the department records and files
- Ensure provider compliance with Patient Status Admit Order (PSAO) co-signatures across the hospital sites covered by centralized UM
- Utilize standard reports/patient lists withing the EHR to identify PSAO co-signature delinquencies and follow up with reminders/escalations to physicians to sign admission orders
- Follow the standard process to notify treating physician via perfect serve or other approved/designated methods of communication
- Interact with Site and System Physician Advisors based on guidelines for escalation
- Document all actions taken and status updates in the EHR
- Maintain PSAO spreadsheet to track signature requests
- Provide support and instruction to physicians to assist in the LOC order signature process
Preferred Qualifications
No preferred qualifications provided.