Utilization Assistant - Acute

Highland Hospital; Charleston (WV); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Comprehensive benefits

Competitive salary

EOE

Job summary

Highland Hospital in Charleston, West Virginia is seeking a Utilization Assistant - Acute to support utilization review activities and coordinate insurance coverage for patients. You will work with admissions, medical records, and payers to verify benefits and ensure timely approvals.

Responsibilities include pre-certifications, post-admission verification, and collaboration with the business office. A High School Diploma is required; a Bachelor's in social work or mental health is preferred,

Qualifications

• Supports utilization review activities to improve collection, reimbursement, coordination, and presentation of information.
• Verifies benefits timely with managed care organizations.
• Pre-certifications and post-admission benefit verification.
• Responds to inquiries from patients, families, and professional referral sources.

Responsibilities

• Assists admissions with pre-certifications of care.
• Reviews medical records for appropriateness of level of care at admission and at intervals.
• Conducts reviews with payers to ensure certification of care.
• Maintains accurate documentation for utilization management.
• Coordinates information with business office to resolve payment problems.
• Attends daily treatment team meetings to discuss patient insurance status.
• Ensures benefits are verified in a timely manner.
• Reports UR or Quality issues to supervisor for timely resolution.
• Responds to telephone and Internet inquiries.
• Researches insurance guidelines for admission and continuing stay criteria.

Skills

Communication

Clinical experience

Inquiry handling

Education

High School Diploma

Bachelor's Degree in social work or mental health

Job description

Utilization Assistant - Acute | Highland Hospital | Charleston, West Virginia

About the Job

The Utilization Assistant provides support to all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information. Works with insurance providers to obtain coverage for patients. Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their families, and professional referral sources.

Roles and Responsibilities

• Assists the admissions department with pre-certifications of care. Performs pre and post admission benefit verification with managed care organizations.
• Reviews medical records of patients for appropriateness of level of care at admission and at intervals determined by documentation in medical record.
• Conducts interactive and timely reviews with payers to ensure certification of care.
• Maintains accurate documentation and files as it relates to utilization management.
• Coordinates information and findings with the business office to help recognize or resolve possible payment problems.
• Attends daily treatment team to discuss patient needs and ensure that all disciplines are aware of patient insurance status and needs.
• Ensure that insurance benefits are verified in a timely manner.
• Communicates any UR or Quality issues as noted in the chart to supervisor immediately to ensure timely resolution of problems.
• Responds to telephone and Internet inquires.
• Researches insurance company guidelines and uses admission and continuing stay criteria for coverage.
• High School Diploma Required, Bachelor's Degree in social work, behavioral or mental health, or other related health field preferred.
• One or more years of direct clinical experience in a psychiatric or mental health setting preferred.

Why Highland Hospital

• Highland Hospital offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications.

Highland Hospital is an EOE.

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