Utilization Analyst

Job Summary

About the role

Coordinates and supervises data management, analyses and reporting for KFH utilization management and Continuing Care Services, SCPMG, KFHP Outside Services management (i.e., day utilization at Outside facilities, and the Emergency Prospective Review Program and Air & Ground Transportation Program, using (implementing and refining) computerized data management systems and in manually maintained utilization data.

Responsibilities

• Coordinates and supervises data and reporting needs, data collection process and data processing issues and provides timely utilization data and analytic support.
• Frequent contacts with other organizational units and outside facilities staff to obtain, verify and/or provide information, e.g., works with Regional Claims and outside hospitals to reconcile billing charges.
• Answers inquiries and educate patients, physicians and hospitals on covered benefits and charges.
• Provides information and assistance to Health Plan members during claims review process and coordinates authorized and non-authorized claims review.
• Determines outside medical services and reinforce procedures for patients seen in outside emergency department.
• May coordinate and supervise Air & Ground Transportation and Prospective Review Authorization Program.
• Captures and maintains the consistency and integrity of the non-KFH utilization bed track computerized data management system.
• May assist in scheduling patient appointments and coordinating patient care.

Requirements

Experience applying analytic techniques and computer skills to hospital data. Strong analytic and verbal skills. Expertise with tracking, spreadsheets and graphic computer systems operating on PC mainframes. Knowledge of health plan benefits. Understanding of medical center operations, complex health systems, with the ability to quickly grasp regional policies, contract interpretation of out-of-plan medical services. Must be able to work in a Labor/Management Partnership environment.

Qualifications

• N/A

Skills

Health Connect experience a plus. Associate of Arts or Bachelors degree preferred. KPHC - Medical records, Foundations / Mainframe experience.

Benefits

N/A

Pay

$31.18 - $33.42 / hour

Schedule

Variable

Worker Location

Onsite

Employee Status

Temporary

Department

Independence Park - Emrgcy Pros Review Progm-EPRP - 0806