Utilization Assistant – Mental Health Payer & Benefit Verifier

University of Rochester; Charleston (WV); On-site; USD 50,000 - 70,000; Full time

Job summary

University of Rochester's Highland Hospital in Charleston, WV is seeking a Utilization Assistant to support utilization review activities, verify benefits, and assist in obtaining coverage for patients. The role involves coordinating with payers and care teams to optimize admission decisions and documentation.

You will interact with patients, families, and providers to ensure timely certification of care, respond to inquiries, and help resolve any insurance or payment issues that arise during

Qualifications

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

Responsibilities

• Assists the admissions department with pre-certifications of care.
• Performs pre and post admission benefit verification with managed care organizations.
• Reviews medical records for appropriateness of level of care at admission and intervals.
• Conducts interactive reviews with payers to ensure certification of care.
• Maintains accurate documentation and files related to utilization management.
• Coordinates information with the business office to resolve payment problems.
• Attends daily treatment team meetings to discuss patient insurance status and needs.
• Ensures insurance benefits are verified in a timely manner.
• Responds to inquiries from patients, families, and referral sources.
• Researches insurance guidelines and uses admission/continuing stay criteria for coverage.

Skills

Payer communication

Documentation

Clinical experience

Education

High School Diploma

Bachelor's Degree in social work/behavioral or mental health or related health field

Job description

University of Rochester's Highland Hospital in Charleston, WV is seeking a Utilization Assistant to support utilization review activities, verify benefits, and assist in obtaining coverage for patients. The role involves coordinating with payers and care teams to optimize admission decisions and documentation.

You will interact with patients, families, and providers to ensure timely certification of care, respond to inquiries, and help resolve any insurance or payment issues that arise during