Job Description
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job responsibilities performed
1. Insurance Authorization
• Maintain an up-to-date patient list and in basket for patients referred to RAC from UMMS member organizations.
• Lead the centralized prior authorization for the PAC admission; coordinate with UMMS case management teams to ensure finalized clinical documents are obtained for insurance review.
• Inputs and updates all pertinent information and data in the EMR.
• Coordinate denial and appeal management for PAC as it effects UMMS, including the peer review process
• Provide PAC bed availability to care management stakeholders across UMMS.
• Perform other duties as assigned.
2. Data Collection and Monitoring
• Engage with the UMAC Director of Data Analytics and Technology Innovation to ensure that the CMA workflows align with the data capturing.
• Monitor data dashboards for accuracy and support performance improvement activities based on the key performance indicator data.
Qualifications
Education & Experience - Required
• High school diploma or equivalency.
• 2 years’ experience in healthcare, or related field.
• Electronic Medical Record (EMR) and insurance authorization experience preferred.
Knowledge, Skills, & Abilities
• Familiarity with medical terminology.
• Familiarity with insurance processes.
• Demonstrated ability to perform basic mathematical calculations including percentage, addition, subtraction, multiplication, and division.
• Ability to use a calculator.
• Ability to operate a computer, with working knowledge of the keyboard configuration.
• Ability to maintain confidentiality with patient and team member information.
• Ability to work independently with minimal supervision.
• Demonstrated resourcefulness, with ability to anticipate needs, prioritize responsibilities and take initiative.
• Detail oriented and ability to meet established deadlines.
• Effective skill managing multiple staff initiatives/priorities and meeting changing requirements and priorities to accomplish objectives.
• Effective skill developing and maintaining collaborative working relationships with all levels of leadership and staff.
• Effective analytical, conceptual thinking, planning, organizational, and problem-solving skills.
• Effective skill in the use of Microsoft Office Suite (e.g., Access, Excel, Word, Outlook, etc.).
• Effective verbal, written and interpersonal communication skills.
Patient Safety
Ensure patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives.
• Act to correct observed risks to patient safety.
• Report adverse events and near misses to appropriate management authority.
• Identify possible risks in processes, procedures, devices and communicate the same to those in charge.
Additional Information
All your information will be kept confidential according to EEO guidelines.
Compensation: