UM Assist

3110 Kennestone Hospital, Inc.; United States; On-site; USD 42,000 - 62,000; Full time

Job summary

Wellstar Health System seeks an Utilization Review Assistant to support the UM Nursing department with non-clinical duties across the system. You will handle clerical tasks, data entry, filing, scheduling, and EPIC-based authorization activities to ensure timely processing.

The role requires 3+ years of clerical/customer service experience, strong MS Office skills, and the ability to work autonomously in a fast-paced hospital environment. Training is provided to support career development.

Qualifications

• High School Graduate.
• Minimum 3 years experience in customer service and clerical work.
• Hospital/medical front and/or back office background preferred.
• Familiarity with EPIC documentation workflows preferred.

Responsibilities

• Answer multi-line incoming calls and route as needed.
• Process faxes, emails, and documents per protocol.
• Maintain electronic files for communications and distribute as appropriate.
• Prepare correspondence and assist with data entry and reports.
• Coordinate with UM Nursing team and escalate denials quickly.

Skills

Time management

Attention to detail

Written communication

Verbal communication

Microsoft Office

Interpersonal skills

Autonomy

Education

High School Diploma

Tools

Microsoft Office Suite

Job description

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift Day (United States of America)

Job Summary

The Utilization Review Assistant supports the UM Nursing department systemwide with non-clinical duties, tasks, and functions within the department to ensure these duties are performed timely. This employee is responsible for selected functions related to general clerical work and support duties that may include work flow maintenance, private and governmental payer authorization related processes, maintaining electric filing system, performing data entry, preparing correspondence, processing documents, managing schedules, answering multi-line phone systems, scanning, faxing, coping, and non-clinical EPIC documentation related to obtaining authorizations. The Utilization Review Assistant will assist UM Nursing team to close EPIC cases that require non-clinical interventions. Training is available.

Core Responsibilities and Essential Functions

• Answer multi-line incoming phone calls, forward calls as appropriate, and review voicemail boxes hourly.
• Produce, distribute, receive, review, and process all faxes and process per protocol.
• Develop and maintain electronic files for incoming communications and disseminate as appropriate.
• Research and create presentations as needed.
• Communicates with appropriate UM Nursing team members related to departmental related duties.
• Prepare and monitor invoices as needed.
• Handle all confidential information in a professional manner.
• Take minutes for departmental staff meetings.
• Monitors for compliance of Medicare/Medicaid regulations, including delivery of MOONs and associated mailing.

EPIC WORKFLOW/DISPOSITION PLANNING

• Supports the UM Nursing team with assigned functions in EPIC work que space related to obtaining timely authorization information and coordinates with UM Nursing team.
• Escalating denial information received immediately to UM Nursing team.
• Develop and maintain contact list.
• Understands eligibility processes and criteria for both private and government payers.
• Places call to payers to update and document authorization information in a timely manner.
• Search payer web portals to update and document authorization information in a timely manner.
• Generate EPIC and other reports as needed.

Documentation

• Document all attempts made to obtain authorizations by phone, fax, or web portal.
• Document receipt of all incoming calls, faxes, or other communicated information related to Centralized UM department activities.
• Document escalation of all denial related communications to UM Nursing team in a timely manner.
• Communicates steps taken and determinations provided by insurance payers/web portals in a timely manner.
• Document the authorizations obtained in the Electronic Health Record.
• Document efforts made to regarding reconsideration efforts with all denials when received.
• Must provide sufficient and appropriate documentation required by GAMMIS for Medicaid pre-cert approvals on the GAMMIS portal.

Professional Development and Initiative

• Completes all initial and ongoing professional competency assessment, required mandatory education, population specific education.
• Develop administrative support staff by providing information, educational opportunities and experimental growth opportunities.
• Performs other duties as assigned
• Complies with all WellStar Health System policies, standards of work, and code of conduct.

Required Minimum Education

High School Graduate

Required Minimum License(s) and Certification(s)

All certifications are required upon hire unless otherwise stated.

Required Minimum Experience

Minimum 3 years experience working with customers/clients and strong clerical background

Required and Strong computer skills and Microsoft office products

Required and Hospital and/or Medical front and/or back office background Preferred

Required Minimum Skills

• Excellent time management skills and proven ability to multi-task and prioritize work.
• Attention to detail and problem-solving skills a must.
• Excellent written and verbal communication skills a must.
• Strong computer skills including: Microsoft office suites with emphasis on Word, Excel, Power Point, Outlook.
• Ability to interact appropriately with stakeholders from various departments.
• Ability to work autonomously a must.
• Strong ability to build and sustain trust with the entire team.

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more. Nationally ranked and locally recognized for our high-quality care and inclusive culture, Wellstar is one of Georgia’s largest and most integrated healthcare systems. Every day, 24,000+ of us work together to provide personalized care for patients at every age and stage of life – and our team members are the foundation of that care.

Mission, Vision & Values

At a time when the healthcare industry is changing rapidly, Wellstar remains committed to exceeding patients’ and team members’ expectations, while transforming healthcare delivery.

OUR MISSION

To enhance the health and well-being of every person we serve.

OUR VISION

Deliver world-class healthcare to every person, every time.

OUR VALUES

We serve with compassion

We pursue excellence

We honor every voice

Culture of Excellence

Wellstar consistently receives attention and accolades from national organizations that set the standards for world-class care. Our system-wide practice of safety principles, assessing and addressing errors and seeking feedback from our patients and customers continually earns recognition for advances in safety and quality.

Featured on the FORTUNE “100 Best Companies to Work For” list and Seramount 100 Best Companies list, we not only provide top-notch care for our patients, but also foster the culture of Wellstar as a Great Place to Work.