Utilization Management Assistant

Santa Barbara Cottage Hospital; United States; Hybrid; USD 40,000 - 55,000; Full time

Job summary

Santa Barbara Cottage Hospital is seeking a Utilization Management Assistant to facilitate and document payer communications while ensuring timely authorization processes. This role requires individuals who can thrive in a team environment and utilize critical thinking skills for process improvement.

Qualified candidates will have at least one year of experience in a medical setting and a high school diploma or GED. The position offers remote work flexibility for candidates in various states.

Qualifications

• Minimum one year experience in healthcare or equivalent.
• Understanding of operations in managed care or utilization management preferred.

Responsibilities

• Receive and document payer requests for clinical documentation.
• Communicate with internal staff regarding documentation requests.
• Identify accounts lacking authorization and follow up with payers.
• Contribute to process improvement opportunities.

Skills

Communication with payers

Critical thinking

Trend identification

Collaboration

Education

High school diploma or GED

Job description

Where You’ll Work

With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

Job Summary and Responsibilities

You have a purpose, unique talents and now is the time to embrace it, live it and put it to work. We value incredible people with incredible skills – but your commitment to a greater cause is something we value even more. This is the heartbeat of our organization and your time will be spent in a supportive, team environment with resources to help you flourish and leaders who care about your success.

As a Utilization Management Assistant you will receive, process, facilitate and document all payer communications. This position supports denial mitigation by sending documentation within the contracted time period, following up on accounts lacking authorization and communicating with internal stakeholders to ensure the accurate submission of clinical documentation to third party payers. The Utilization Management Assistant supports the Utilization Management Hub department by recognizing trends and opportunities for process improvement and reporting those to leadership. The Utilization Management Assistant performs these duties with a high degree of accuracy utilizing critical thinking skills and in compliance with hospital policies, standards of practice and Federal and State Regulations.

• Receives, sends and documents payer requests for clinical documentation.
• Receives and documents payer authorization and communications including but not limited to concurrent denials.
• Coordination of peer to peer conversations, as applicable.
• Reviews surgery schedule to verify correct authorization is documented, if applicable.
• Identifies accounts lacking authorization and follows up with payers, as needed.
• Communicates with interdepartmental staff regarding payer documentation requests.
• Under RN direction submits requests for and follows up on administrative days authorization, where indicated.
• Identifies and reports trends to department Leadership.
• Utilizes payer related reports from Care Management software, where applicable.
• Collaborates with and supports the UM team including but not limited to UR and Denials RN.
• Contributes to the identification of opportunities for process improvement.
• Supports administrative departmental functions, as assigned.

This position is open to remote/out of state candidates residing in only these states:

Alabama- Arizona- Arkansas- Colorado - Florida- Georgia - Idaho- Indiana - Iowa- Kansas - Kentucky- Louisiana -Missouri- Mississippi- Nebraska- New Mexico - Nevada - North Carolina - Ohio- Oklahoma- South Carolina - South Dakota- Tennessee- Texas- Utah - Virginia- West Virginia - Wyoming

Job Requirements

In addition to bringing humankindness to the workplace each day, qualified candidates will need the following:

• Minimum one year experience in a hospital, physician’s office, or medical group performing duties related to admitting, business office, payer communications or managed care or an equivalent combination of education and experience
• High school diploma or GED

Preferred

An understanding of operations and functions of care coordination, utilization management, denials mitigation is preferred.

Physical Requirements-Sedentary work -(prolonged periods of sitting and exert up to 10lbs force occasionally)