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

2310 AU Medical Center, Inc.; United States; Presencial; USD 30.000 - 47.000; Jornada completa

Descripción de la vacante

Wellstar Health System, Inc. is seeking a Utilization Review Assistant to support the UM Nursing department with non-clinical duties across the system.

The role focuses on clerical tasks, workflow maintenance, and processing payer authorizations, while maintaining electronic files and handling EPIC documentation related to authorizations. The ideal candidate will have strong organizational skills, a solid clerical background, and experience with Medicare/Medicaid processes.

Formación

• High School Diploma or GED required.
• Minimum 3 years customer service and clerical experience.
• Strong computer skills and Microsoft Office proficiency.
• Hospital/medical front or back office background preferred.
• Excellent time management and ability to multi-task.
• Attention to detail and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to work autonomously.

Responsabilidades

• Answer multi-line phone system, forward calls and monitor voicemail hourly.
• Process faxes and per protocol; manage electronic filing.
• Prepare correspondence and documents; maintain schedules.
• Assist with EPIC workflow for obtaining timely authorizations.
• Document and track authorizations and communications with payers.
• Generate EPIC reports and maintain payer contact lists.

Conocimientos

Time management

Multi-tasking

Attention to detail

Written and verbal communication

Educación

High School Diploma / GED

Herramientas

Microsoft Office

EPIC

Descripción del empleo

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) 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 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 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 and Strong computer skills and Microsoft office products

Required and 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.

Nationally ranked and locally recognized for our high-quality care and inclusive culture, Wellstar is one of Georgia’s largest and most integrated healthcare systems. Every day, 24,000+ of us work together to provide personalized care for patients at every age and stage of life – and our team members are the foundation of that care.

Mission, Vision & Values

At a time when the healthcare industry is changing rapidly, Wellstar remains committed to exceeding patients’ and team members’ expectations, while transforming healthcare delivery.

OUR MISSION: To enhance the health and well-being of every person we serve. OUR VISION: Deliver world-class healthcare to every person, every time. OUR VALUES: We serve with compassion We pursue excellence We honor every voice Culture of Excellence Wellstar consistently receives attention and accolades from national organizations that set the standards for world-class care. Our system-wide practice of safety principles, assessing and addressing errors and seeking feedback from our patients and customers continually earns recognition for advances in safety and quality.