Utilization Review Coordinator

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. Requests and technically reviews medical documentation from SNF’s

2. Assists SNF’s with questions as related to request for medical documentation

3. Maintains and follow-ups on all medical review audits with insurance payers and SNF’s

4. Uses tracking system to keep accurate record of all documentation processed in assigned area

5. Maintains the privacy and confidentiality of protected health information, as well as sensitive information pertaining to other partners of Care Management.

6. Ability to perform assigned job duties under constant time pressures and changing priorities and deadlines.

7. Work in a team environment with minimal supervision.

8. Must deliver exceptional customer service at all times.

9. Performs other roles, related duties as required by supervisor.

10. Must have a timely, regular attendance.

11. Attend professional training as directed.

KNOWLEDGE, SKILLS, ABILITIES:

1. Keyboard proficiency

2. Problem solving skills

3. Medical assessment and documentation skills

4. Excellent customer service and communication skills

5. Must be able to maintain confidentiality regarding patient and company proprietary information

6. Must have the ability to relate professionally and positively and work cooperatively with patients, families, and other employees at all levels

MINIMUM EDUCATION REQUIRED:

Education Requirement: High school diploma or equivalent

MINIMUM EXPERIENCE REQUIRED:

1. Minimum 3 years’ experience in healthcare preferably in a long-term care environment

2. Working knowledge of registration systems for patient documentation and billing

3. Knowledge of commercial insurance and case management criteria.

4. Knowledge of industry payment/ reimbursement and methodology and ADR processes

5. Understanding of state and federal regulations

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. One (1) year experience in medical insurance billing, medical accounts receivable or similar medical business

office experience

2. Work within scope of job requirements

3. Ability to multi-task and handle consistent workflow

4. Ability to think critically and work independently

5. Develop and foster relationships

6. Good listening skills

7. Initiative to follow-up on pending issues and organize and assign work

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.

We are eager to connect with you! Apply Now to get started at PruittHealth!

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