Utilization Review Coordinator

Christian City Inc.; Norcross (GA); On-site; USD 42,000 - 54,000; Full time

Job summary

Pruitthealth Corporation in Norcross, GA is seeking a Care Integration Utilization Review Coordinator to gather, review and track medical documentation requests and ensure timely responses.

You will work with SNFs, maintain confidentiality, and coordinate with insurance payers, using a tracking system and delivering excellent customer service.

The role requires attention to detail, the ability to multitask under deadlines, and collaboration within a team.

Qualifications

• High school diploma or equivalent required.
• Healthcare documentation experience is preferred.
• Knowledge of insurance billing processes is a plus.

Responsibilities

• Requests and reviews medical documentation from SNFs.
• Assist SNFs with questions related to requests.
• Maintain and follow up on medical review audits with payers and SNFs.
• Use tracking system to record all documentation processed.
• Maintain confidentiality of patient information.
• Work under time pressures and changing priorities.
• Collaborate with team with minimal supervision.
• Deliver exceptional customer service.
• Perform additional duties as assigned.
• Maintain timely, regular attendance.
• Attend professional training as directed.

Skills

Keyboard proficiency

Medical assessment & documentation

Customer service & communication

Confidentiality & privacy

Team collaboration

Time management under deadlines

Education

High school diploma or equivalent

Tools

MS Office Suite

Job description

Description

JOB PURPOSE:

The Care Integration Utilization Review Coordinator will be responsible for gathering, reviewing and tracking all documents associated with clinical documentation requests. Maintains information regarding these requests and coordinates responses and outcomes timely.

KEY RESPONSIBILITIES:

1. 1.Requests and technically reviews medical documentation from SNF’s
2. 2.Assists SNF’s with questions as related to request for medical documentation
3. 3.Maintains and follow-ups on all medical review audits with insurance payers and SNF’s
4. 4.Uses tracking system to keep accurate record of all documentation processed in assigned area
5. 5.Maintains the privacy and confidentiality of protected health information, as well as sensitive information pertaining to other partners of Care Management.
6. 6.Ability to perform assigned job duties under constant time pressures and changing priorities and deadlines.
7. 7.Work in a team environment with minimal supervision.
8. 8.Must deliver exceptional customer service at all times.
9. 9.Performs other roles, related duties as required by supervisor.
10. 10.Must have a timely, regular attendance.
11. 11.Attend professional training as directed.

KNOWLEDGE, SKILLS, ABILITIES:

1. 1.Keyboard proficiency
2. 3.Medical assessment and documentation skills
3. 4.Excellent customer service and communication skills
4. 5.Must be able to maintain confidentiality regarding patient and company proprietary information
5. 6.Must have the ability to relate professionally and positively and work cooperatively with patients, families, and other employees at all levels

Qualifications

MINIMUM EDUCATION REQUIRED:

Education Requirement:High school diploma or equivalent

MINIMUM EXPERIENCE REQUIRED:

1. 1.Minimum 3 years’ experience in healthcare preferably in a long-term care environment
2. 2.Working knowledge of registration systems for patient documentation and billing
3. 3.Knowledge of commercial insurance and case management criteria.
4. 4.Knowledge of industry payment/ reimbursement and methodology and ADR processes
5. 5.Understanding of state and federal regulations
6. 6.Proficiency in MS Office Suite (Excel, Visio, PowerPoint, Word, Outlook, Skype, etc.)

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:

N/A

ADDITIONAL QUALIFICATIONS: (Preferred qualifications)

1. 1.One (1) year experience in medical insurance billing, medical accounts receivable or similar medical business
2. 2.Work within scope of job requirements
3. 3.Ability to multi-task and handle consistent workflow
4. 4.Ability to think critically and work independently
5. 5.Develop and foster relationships
6. 7.Initiative to follow-up on pending issues and organize and assign work
7. 8.Effective oral, written and telephone skills

Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.

As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.

For Florida Job Postings Only:

For more information regarding Florida’s Care Provider Background Screening Clearinghouse Education and Awareness, please visit https://info.flclearinghouse.com