Utilization Mgmt Rep

Utilization Mgmt Rep

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.