Utilization Management Clinical Assistant

Position Highlights

Position: Utilization Management Clinical Assistant
Location: LOH- Corp Center- Warrenville, IL
Full Time/Part Time: Full Time (40 hours)
Hours: Monday-Friday

What You Will Do

• Demonstrates the knowledge and skills necessary to provide care appropriate to the age of patients served.
• Completes discharge reviews.
• Sends missing charge emails to Billing Specialist as necessary.
• Supports ancillary details of authorizations by completing authorization by any means necessary (live/telephonic, chart support, fax or portal).
• Adds cases identified from paperwork and/or Utilization Review Coordinators to Clinical Appeals Log for tracking purposes.
• Affixes new cases to the Financial Appeals Log.
• Supports identifying integral denial/appeal/approval paperwork to identify for scanning purposes or distribution or charting purposes.
• Reviews the Appeals Log for inpatient/partial hospitalization program/intensive outpatient program cases and read through the clinical documentation for the patient case.
• Writes letter to insurance organization requesting reconsideration for their denial of services.
• Makes follow-up phone calls to insurance companies on status of pending appeals.
• Collaborates with Business Office and Coordinators, Utilization Management regarding benefit issues/questions as needed.
• Collaborates with Billing & Collection Specialist for quarterly reporting presentations and adds UM appeals statistics to presentation.

What You Will Need

• Bachelor's Degree Required
• Proficiency in Microsoft Office products
• Familiarity with behavioral health field, terminology and levels of care
• Knowledge of DSM IVR (Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteria
• Experience completing and submitting insurance appeals
• Knowledge of insurance benefits, authorization requirements, and payer appeal processes

Benefits

• Premium pay such as shift, on call, holiday and more based on an employee’s job
• Incentive pay for select positions
• Opportunity for annual increases based on performance
• Career Pathways to Promote Professional Growth and Development
• Variety of Medical, Dental, Pet and Vision options
• Tuition Reimbursement
• Free Parking
• Wellness Program Savings Plan
• Health Savings Account Options
• Retail Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities

About the Role

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals – Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) – all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org. When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Company Information

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

EEO Statement

EEO: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.