Utilization Management Specialist - FT, Days

Prisma Health; Columbia (SC); On-site; USD 38,000 - 48,000; Full time

Job summary

Prisma Health seeks an Administrative Data Clerk in Columbia, SC to provide clerical and data management support. You will collect and summarize routine operational data, enter data for assigned patient populations, and obtain authorizations for treatment while assisting with administrative duties.

Responsibilities include generating reports, maintaining authorization numbers, and responding to payor requests.

Qualifications

• Two years of clerical or administrative experience.
• Basic understanding of common medical and financial terminology preferred.
• High School diploma or equivalent required; Associate degree preferred.

Responsibilities

• Run daily, weekly, monthly and quarterly reports.
• Obtain authorizations for treatment and submit to payors.
• Enter data for assigned patient populations and ensure accuracy.
• Maintain and update authorization numbers in registration/case management systems.
• Respond to payor requests for additional documentation timely.
• Assist with discharge planning communications with vendors/providers.

Skills

Clerical experience

Medical terminology

Education

Associate degree in Business or Healthcare related field

Job description

• Secures discharge dates for payers.

Inspire health. Serve with compassion. Be the difference.

Job Summary

Provides clerical and data management support. Collects and summarizes routine operational and productivity data. Collects and enters data for assigned patient populations. Obtains authorizations for treatment and makes referrals where appropriate. Assists with administrative duties.

Job Description

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
• Runs daily, weekly, monthly and quarterly reports
• Obtains and submits appropriate clinical documentation to the payors. Responds to payor requests for additional documentation timely and accurately.
• Updates and maintains authorization numbers and approved days in registration and/or case management systems
• Obtains appropriate statistical data for patients in assigned patient population areas and communicates data to payors
• Enters payor denial data into denial management or case management system
• Answers, screens and prioritizes telephone calls, utilizing sound judgement regarding the urgency and content of the information
• Processes faxes to and from payers for the Case Management team as assigned.
• Secures discharge dates for payers.
• Provides assistance with the discharge planning process including but not limited to sending information to receiving information from appropriate vendors/providers.
• Ensures data entry is completed timely and accurately.
• Ensures payor communication is completed timely and accurately.
• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education - High School diploma or equivalent. Associate degree in Business or Healthcare related field of study preferred
• Experience - Two (2) years of clerical or administrative experience

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills And Abilities

• Basic understanding of common medical and financial terminology preferred

Work Shift

Day (United States of America)

Location

3 Medical Park Rd Richland

Facility

Richland Hospital

Department

EEG and Sleep Lab Admin

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.