Utilization Review Assistant

Wellstar Health System; Austell (GA); On-site; USD 42,000 - 58,000; Full time

Job summary

Wellstar Cobb Hospital is seeking a Utilization Review Assistant to support the UM Nursing department with non-clinical duties across the system. This role involves clerical tasks, data entry, and processing authorizations in EPIC, with training provided.

The position requires at least 3 years of customer-facing experience, strong clerical skills, and proficiency with Microsoft Office. Hospital front/back office background is preferred, and you will join a collaborative, mission-driven team.

Qualifications

• Minimum 3 years experience working with customers/clients and strong clerical background required.
• Strong computer skills and Microsoft Office products required.
• Hospital and/or Medical front/back office background preferred.

Responsibilities

• Answer multi-line incoming phone calls, forward calls as appropriate and review voicemail boxes hourly.
• Produce, distribute, receive, review and process all faxes per protocol.
• Develop and maintain electronic files for incoming communications.
• Research and create presentations as needed.
• Communicate with UM Nursing team on departmental duties.
• Prepare and monitor invoices as needed.
• Handle confidential information professionally.
• Take minutes for departmental meetings.
• Monitor compliance with Medicare/Medicaid regulations and MOONs.

Skills

Time management

Attention to detail

Written and verbal communication

MS Office

Stakeholder interaction

Autonomy

Trust building

Education

High School Diploma

Tools

Microsoft Office

Job description

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift

Day (United States of America)

Come join our Cobb Hospital Care Coordination/Utilization Review team!

About The Facility

Learn more about Wellstar Cobb Hospital, including our teams, culture and campus environment:

https://www.wellstar.org/locations/hospital/cobb-medical-center

Shift Hours

FT Days

Minimum 3 years experience working with customers/clients and strong clerical background Required and Strong computer skills and Microsoft office products Required and Hospital and/or Medical front and/or back office background Preferred

Job Summary

The Utilization Review Assistant supports the UM Nursing department systemwide with non-clinical duties, tasks, and functions within the department to ensure these duties are performed timely. This employee is responsible for selected functions related to general clerical work and support duties that may include workflow maintenance, private and governmental payer authorization related processes, maintaining electric filing system, performing data entry, preparing correspondence, processing documents, managing schedules, answering multi-line phone systems, scanning, faxing, copying, and non-clinical EPIC documentation related to obtaining authorizations. The Utilization Review Assistant will assist UM Nursing team to close EPIC cases that require non-clinical interventions. Training is available.

Core Responsibilities And Essential Functions

ASSESSMENT / CLERICAL SUPPORT

• Answer multi-line incoming phone calls, forward calls as appropriate, and review voicemail boxes hourly.
• Produce, distribute, receive, review, and process all faxes and process per protocol.
• Develop and maintain electronic files for incoming communications and disseminate as appropriate.
• Research and create presentations as needed,
• Communicates with appropriate UM Nursing team members related to departmental related duties.
• Prepare and monitor invoices as needed.
• Handle all confidential information in a professional manner.
• Take minutes for departmental staff meetings.
• Monitors for compliance of Medicare/Medicaid regulations, including delivery of MOONs and associated mailing.

EPIC WORKFLOW/DISPOSITION PLANNING

• Supports the UM Nursing team with assigned functions in EPIC work queue space related to obtaining timely authorization information and coordinates with UM Nursing team.
• Escalating denial information received immediately to UM Nursing team.
• Develop and maintain contact list
• Understands eligibility processes and criteria for both private and government payers. Places call to payers to update and document authorization information in a timely manner.
• Search payer web portals to update and document authorization information in a timely manner.
• Generate EPIC and other reports as needed.

Documentation

• Document all attempts made to obtain authorizations by phone, fax, or web portal.
• Document receipt of all incoming calls, faxes, or other communicated information related to Centralized UM department activities.
• Document escalation of all denial related communications to UM Nursing team in a timely manner.
• Communicates steps taken and determinations provided by insurance payers/web portals in a timely manner
• Document the authorizations obtained in the Electronic Health Record
• Document efforts made to regarding reconsideration efforts with all denials when received
• Must provide sufficient and appropriate documentation required by GAMMIS for Medicaid pre-cert approvals on the GAMMIS portal.

Professional Development and Initiative

• Completes all initial and ongoing professional competency assessment, required mandatory education, population specific education.
• Develop administrative support staff by providing information, educational opportunities and experimental growth opportunities.

Performs other duties as assigned

Complies with all WellStar Health System policies, standards of work, and code of conduct.

Required Minimum Education

High School Graduate

Required Minimum License(s) And Certification(s)

All certifications are required upon hire unless otherwise stated.

Required Minimum Experience

Minimum 3 years experience working with customers/clients and strong clerical background Required and

Strong Computer Skills And Microsoft Office Products

Strong computer skills and Microsoft office products Required and

Hospital and/or Medical front and/or back office background Preferred

Hospital and/or Medical front and/or back office background Preferred

Required Minimum Skills

• Excellent time management skills and proven ability to multi-task and prioritize work.
• Attention to detail and problem-solving skills a must.
• Excellent written and verbal communication skills a must.
• Strong computer skills including: Microsoft office suites with emphasis on Word, Excel, Power Point, Outlook.
• Ability to interact appropriately with stakeholders from various departments.
• Ability to work autonomously a must.
• Strong ability to build and sustain trust with the entire team.

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.