Utilization Assistant - Acute

summitbhc; United States; On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

EOE

Job summary

Highland Hospital in Charleston, West Virginia, seeks an Utilization Assistant to support utilization review and management activities, improving coverage and reimbursement for patients.

The role involves assisting admissions with pre-certifications, verifying benefits, and coordinating with payers. You will participate in treatment team discussions and maintain meticulous documentation of utilization information.

Qualifications

• High School Diploma required; Bachelor's degree preferred in social work or related health field.
• 1+ year of direct clinical experience in psychiatric/mental health preferred.

Responsibilities

• Assist admissions with pre-certifications of care.
• Verify benefits pre and post admission with managed care.
• Review patient records for appropriate level of care at admission and as required.
• Conduct timely reviews with payers to secure certification of care.
• Maintain accurate UR/UM documentation and files.
• Coordinate information with business office to resolve payment issues.
• Attend daily treatment team to discuss patient insurance status.
• Verify benefits in a timely manner and communicate UR/QA issues to supervisor.
• Answer telephone and internet inquiries; research payer guidelines.

Skills

Pre-certifications

Benefit verification

Payer communication

Documentation

Team collaboration

Education

High School Diploma

Bachelor’s degree in social work or related 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.

Required Qualifications:

• 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.