Utilization Management Liaison & Denials Specialist

San Juan Regional Medical Center; Farmington (NM); Sur place; USD 40 000 - 55 000; Plein temps

Résumé du poste

San Juan Regional Medical Center in Farmington, NM is seeking a Utilization Management Assistant to support the UM team by handling authorizations, documenting denials, and assisting with peer-to-peer discussions for denial mitigation. This role requires precise communication with payors and accurate documentation through the EMR and payor portals.

You will work in a fast-paced healthcare setting, demonstrate strong organizational skills, and manage multiple priorities while upholding SJRMC’s

Qualifications

• High school diploma or equivalent required.
• Five years of healthcare or insurance experience.
• Strong communication and customer service skills.
• Ability to work autonomously and manage priorities.
• Familiarity with Excel and Office programs.
• Knowledge of insurance and billing requirements.

Responsabilités

• Receives clinical denials through phone calls, fax and EMR
• Documents inpatient authorizations and payor communication
• Provides initial and concurrent clinicals to payors through EMR and payor portals
• Maintains denial and appeal work queues for the UM team
• Reviews and compiles denial and appeal documentation in a timely manner
• Tracking and monitoring concurrent and retrospective denials
• Assists with coordination of peer-to-peer conversations for denial mitigation
• Coordinates W2 meetings and completes provider correspondence
• Exhibits effective communication
• Performs related duties and responsibilities as required.
• All SJRMC Employees are responsible for implementing SJRMC’s Service Standards into their activities: Safety, Courtesy, Effectiveness, and Stewardship
• Other duties as assigned

Connaissances

Strong communication skills

Excellent customer service

Ability to function autonomously

Prioritization when dealing with multi

Experience in healthcare/insurance

Formation

High School diploma or equivalent

Outils

Excel

Office Suite

Description du poste

San Juan Regional Medical Center in Farmington, NM is seeking a Utilization Management Assistant to support the UM team by handling authorizations, documenting denials, and assisting with peer-to-peer discussions for denial mitigation. This role requires precise communication with payors and accurate documentation through the EMR and payor portals.

You will work in a fast-paced healthcare setting, demonstrate strong organizational skills, and manage multiple priorities while upholding SJRMC’s