Utilization Assistant - Acute

Highland; Charleston, Northern (WV, KY); Hybrid; USD 36,000 - 54,000; Full time

Job summary

Highland Hospital in Charleston, West Virginia is seeking a Utilization Assistant - Acute to support utilization review activities, coordinate benefits verification, and communicate with payers and patients to secure appropriate coverage. The role involves reviewing medical records for level of care, performing pre-certifications, and assisting in appeals.

A High School Diploma is required; a Bachelor’s degree in social work or related health field is preferred, with 1+ year clinical psychiatric

Qualifications

• High School Diploma required; Bachelor’s degree in social work, behavioral or mental health, or related health field preferred.
• One or more years of direct clinical experience in a psychiatric or mental health setting preferred.

Responsibilities

• Assists admissions with pre-certifications of care and benefit verification with managed care organizations.
• Reviews medical records for appropriateness of level of care at admission and intervals.
• Conducts reviews with payers to ensure certification of care and assists in appeals.
• Maintains accurate documentation and files related to utilization management.
• Coordinates information with the business office to resolve payment issues.
• Attends daily treatment team meetings to discuss patient insurance status.

Education

High School Diploma

Bachelor’s Degree in social work, behavioral or mental health, or related health field

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. Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.