Utilization Management Clinical Assistant

Endeavor-Health; Warrenville (IL); On-site; USD 31,000 - 46,000; Full time

Benefits offered by this job

Shift pay

Holiday pay

Tuition reimbursement

Paid time off

Free parking

Wellness program

Job summary

Endeavor Health is seeking a Utilization Management Clinical Assistant in Warrenville, IL to support the UM Coordinator with precerts and discharge reviews. You will help prepare and track insurance appeals and follow up on status with payers, coordinating effort prior to patient discharge.

The role requires a Bachelor's degree and familiarity with behavioral health terminology, DSM-IVR, and payer processes.

Qualifications

• Bachelor's degree required in a related field.
• Familiarity with behavioral health terminology is expected.
• Experience submitting and tracking insurance appeals.
• Knowledge of DSM IVR diagnostic criteria and payer processes.

Responsibilities

• Support the UM Coordinator by handling precerts and discharge reviews.
• Prepare appeals and follow up on insurance status with payers.
• Update Appeals Log and assist with data for meetings.
• Assist in coordinating appeal efforts prior to discharge.
• Communicate with Billing & Communications teams as needed.

Skills

Behavioral health terminology

Insurance benefits knowledge

Payer appeal processes

Communication skills

Education

Bachelor's degree

Tools

Microsoft Office

DSM-IVR

Insurance appeals software

Job description

Hourly Pay Range:$22.14 - $33.21 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.Position Highlights:Position: Utilization Management Clinical AssistantLocation: LOH- Corp Center- Warrenville, ILFull Time/Part Time: Full Time (40 hours)Hours: Monday-FridayRequired Travel: N/AA Brief Overview:Supports the Coordinator, Utilization Review by assisting with the workflow which includes conducting precerts and discharge reviews, preparing appeals and completing insurance follow up calls on status.What you will do:Demonstrates the knowledge and skills necessary to provide care appropriate to the age of patients served. This includes knowledge of the physical and psychological needs of patients served and the ability to respond appropriately to those needs.Understands where to locate information, if needed to present case specific information, by means of the chart or clinic documentation.Completes discharge reviews.Checks charges, attendance functionality , and notes to check outpatient days attended. Sends missing charge emails to Billing Specialist as necessary.Supports ancillary details of authorizations by completing authorization by any means necessary (live/telephonic, chart support, fax or portal).Identifies new cases to be added to the Financial Appeals Log.Adds cases identified from paperwork and/or Utilization Review Coordinators to Clinical Appeals Log for tracking purposes.Assist in coordinating appeal efforts prior to patient’s discharge.Supports identifying integral denial/appeal/approval paperwork to identify for scanning purposes or distribution or charting purposes.Reviews the Appeals Log for inpatient/partial hospitalization program/intensive outpatient program cases and read through the clinical documentation for the patient case. Writes letter to insurance organization requesting reconsideration for their denial of services.May participate in contributing with any needed pieces for recredentialing applications or contracts.Updates Appeals Log statistics.Prepares data for the UM Committee meeting minutes as needed.Makes follow-up phone calls to insurance companies on status of pending appeals.Coordinates with Business Office and Coordinators, Utilization Management regarding benefit issues/questions as needed.Coordinates with Billing & Collection Specialist for quarterly reporting presentations and adds UM appeals statistics to presentation.What you will need:Bachelors Degree RequiredProficiency in Microsoft Office productsFamiliarity with behavioral health field, terminology and levels of careKnowledge of DSM IVR (Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteriaExperience completing and submitting insurance appeals.Knowledge of insurance benefits, authorization requirements, and payer appeal processes.Benefits (For full time or part time positions):Premium pay such as shift, on call, holiday and more based on an employee’s jobIncentive pay for select positionsOpportunity for annual increases based on performanceCareer Pathways to Promote Professional Growth and DevelopmentVarious Medical, Dental, Pet and Vision optionsTuition ReimbursementFree ParkingWellness Program Savings PlanHealth Savings Account OptionsRetirement Options with Company MatchPaid Time Off and Holiday PayCommunity Involvement OpportunitiesEndeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals – Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) – all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to “help everyone in our communities be their best”.Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.At Endeavor Health, we are united by a shared commitment to working together to create a culture of connection and belonging—each of us bringing different skills and experiences as we deliver safe, seamless, and personal care. Every person, every time. We are committed to fostering an environment where all team members can be their best, learn, and pursue excellence together.EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.