Home Health Utilization Review Specialist

Berkshire Health Systems; Pittsfield (MA); Presencial; USD 56.000 - 83.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health and dental insurance

Competitive retirement plan

Paid time off

Descripción de la vacante

Berkshire Medical Center in Pittsfield, MA seeks an Utilization Program Specialist to evaluate the necessity and appropriateness of services, supporting case management and reimbursement aligned with BVNA standards. The role coordinates medical coding and supports clinical managers to ensure compliant, cost-efficient home health care.

Requirements include a minimum of 3 years in a certified home health agency, MA RN licensure, and Home Health coding certification.

Formación

• Minimum of 3 years of work experience in a certified home health agency.
• Knowledge of current regulations governing third party reimbursement for home health.
• Ability to cooperate, guide and instruct a multi-disciplinary team.
• Demonstrated ability to conform with Service Excellence Standards.

Responsabilidades

• Evaluate necessity and appropriateness of services to ensure effectiveness and cost efficiency.
• Assist clinical staff with case management and ensure care is delivered per BVNA standards and regulatory requirements.
• Provide direction and act as a resource for Clinical Managers and staff regarding reimbursement.
• Translate medical information into medical codes according to home health coding conventions.

Conocimientos

Time management

Multidisciplinary teamwork

Problem solving

Confidentiality

Educación

BSN preferred

Home Health coding certification

Descripción del empleo

Berkshire Medical Center in Pittsfield, MA seeks an Utilization Program Specialist to evaluate the necessity and appropriateness of services, supporting case management and reimbursement aligned with BVNA standards. The role coordinates medical coding and supports clinical managers to ensure compliant, cost-efficient home health care.

Requirements include a minimum of 3 years in a certified home health agency, MA RN licensure, and Home Health coding certification.