Utilization Review Assistant - Utilization Management - FT/Day - Augusta

Wellstar Health System, Inc.; Augusta (GA); On-site; USD 40,000 - 52,000; Full time

Job summary

Wellstar Health System, Inc. is seeking a Utilization Review Assistant for the Utilization Management department in Augusta, GA. This full-time day shift role includes non-clinical duties, data entry, filing, and coordinating payer authorizations in EPIC.

The position supports the UM Nursing team with workflow, documentation, and escalation of denial information. Training is available and previous hospital/office experience is valued.

Qualifications

• High School Diploma or GED required.
• Minimum 3 years experience in customer service with strong clerical background.
• Strong computer skills and proficiency in Microsoft Office applications.
• Hospital and/or medical front and/or back office background preferred.

Responsibilities

• Answer multi-line incoming calls and manage messages.
• Process faxes and documents per protocol.
• Maintain electronic files and assist with data entry.
• Prepare correspondence and monitor schedules.
• Assist UM Nursing team with EPIC workflows and authorizations.
• Document communications and authorizations accurately in the EMR.

Skills

Time management

Multi-tasking

Attention to detail

Written communication

Verbal communication

MS Office

Outlook

PowerPoint

Excel

Word

Stakeholder liaison

Autonomy

Problem solving

Education

High School Diploma / GED

Tools

EPIC

GAMMIS portal

Job description

Utilization Review Assistant - Utilization Management - FT/Day - AugustaWe use cookies to offer you a better browsing experience analyze site traffic, and personalize content. Read about how we use cookies and how you can control them by visiting our Cookie Settings page . If you continue to use this site, you consent to our use of cookies.# Search for Jobs## Utilization Review Assistant - Utilization Management - FT/Day - AugustaApply: AU Medical Center, Inc.: Full time: Posted Today: JR-76367How 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)## **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 work flow 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, coping, 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 que 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 portalProfessional 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 assignedComplies with all Wellstar Health System policies, standards of work, and code of conduct.## **Required Minimum Education:*** High School Diploma / GED General## **Required Minimum License(s) and Certification(s):**All certifications are required upon hire unless otherwise stated.## **Additional License(s) and Certification(s):**## **Required Minimum Experience:**Minimum 3 years experience working with customers/clients and strong clerical background Required andStrong computer skills and Microsoft office products Required andHospital 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.