Acute Utilization Specialist: Coverage & Appeals

summitbhc; United States; On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

EOE

Job summary

Highland Hospital in Charleston, West Virginia, seeks an Utilization Assistant to support utilization review and management activities, improving coverage and reimbursement for patients.

The role involves assisting admissions with pre-certifications, verifying benefits, and coordinating with payers. You will participate in treatment team discussions and maintain meticulous documentation of utilization information.

Qualifications

• High School Diploma required; Bachelor's degree preferred in social work or related health field.
• 1+ year of direct clinical experience in psychiatric/mental health preferred.

Responsibilities

• Assist admissions with pre-certifications of care.
• Verify benefits pre and post admission with managed care.
• Review patient records for appropriate level of care at admission and as required.
• Conduct timely reviews with payers to secure certification of care.
• Maintain accurate UR/UM documentation and files.
• Coordinate information with business office to resolve payment issues.
• Attend daily treatment team to discuss patient insurance status.
• Verify benefits in a timely manner and communicate UR/QA issues to supervisor.
• Answer telephone and internet inquiries; research payer guidelines.

Skills

Pre-certifications

Benefit verification

Payer communication

Documentation

Team collaboration

Education

High School Diploma

Bachelor’s degree in social work or related field

Job description

Highland Hospital in Charleston, West Virginia, seeks an Utilization Assistant to support utilization review and management activities, improving coverage and reimbursement for patients.

The role involves assisting admissions with pre-certifications, verifying benefits, and coordinating with payers. You will participate in treatment team discussions and maintain meticulous documentation of utilization information.