UM Front-End Specialist — Reimbursement Impact

Tampa General Hospital; Tampa (FL); On-site; USD 55,000 - 75,000; Full time

Job summary

Tampa General Hospital is seeking a Utilization Management Extender in Case Management to support front-end UM workflows, ensure timely authorization and documentation, and collaborate across Coding, HIM, Billing, and Revenue Integrity. The role emphasizes preventing denials through proactive reviews and accurate payer communications.

Responsibilities include admission authorizations, level-of-care changes, and concurrent reviews, with a focus on reconciling authorization activity during the

Qualifications

• Front-end Utilization Management workflows knowledge.
• Ability to interpret payer rules and documentation.
• Experience with EMR systems (Epic) and revenue cycle modules.

Responsibilities

• Validate admissions, notifications, level-of-care changes, and concurrent reviews.
• Collaborate with Case Management to track determinations for appeals.
• Submit and follow NOA, level-of-care changes, and concurrent submissions.
• Reconcile UM activity to ensure billing readiness.
• Identify barriers to claim release and resolve DNB work queues.
• Maintain payer communications and documentation in Epic.
• Escalate complex UM or payer issues to leadership as needed.
• Participate in audits and process-improvement initiatives related to UM.

Skills

Front-end UM workflows

Payer rules understanding

Epic utilization experience

Communication skills

Analytical thinking

Time management

Education

High School Diploma or GED

Tools

Epic Resolute

Payer portals

Job description

Tampa General Hospital is seeking a Utilization Management Extender in Case Management to support front-end UM workflows, ensure timely authorization and documentation, and collaborate across Coding, HIM, Billing, and Revenue Integrity. The role emphasizes preventing denials through proactive reviews and accurate payer communications.

Responsibilities include admission authorizations, level-of-care changes, and concurrent reviews, with a focus on reconciling authorization activity during the