Utilization Review Assistant

Position Summary

The Outpatient Utilization Review Assistant, using decision trees and standard work, is responsible for a broad range of utilization review support services to ensure efficient authorization coordination including registering patients, eligibility verification, scheduling patient visits, obtaining authorizations, preparing billing data through data entry in EMR and 3rd party billing systems, maintaining patient information through chart documentation in EMR, preparing required reports and providing other support as requested.

Essential Functions And Responsibilities Of The Job

• Appropriate chart documents are chosen and transmitted per decision trees and standard work to submit for authorization requests.
• Provides clerical support services including triaging telephone calls, mailing and faxing correspondences and printing reports.
• Obtains initial patient demographics, including referring/ordering physician and third party/guarantor information and documents in EMR per standard work.
• Chart documentation is transmitted per department timeliness requirements.
• Documentation in the billing system of activities and authorizations is complete and timely.
• Duties performed meet department productivity requirements.
• Timely notification (prior to services rendered for elective admissions and within 24 hours and/or the next business day for urgent/emergency admissions) to all insurance/medical groups.
• Verifies eligibility, obtains benefit plan information and secures authorization when necessary.
• Communicates authorization received per standard work.
• Cross-trains to cover front desk, scheduling and registration.
• Performs other duties as assigned.

Minimum Requirements

• 2+ years medical office/UR Department/Admitting Central Auth Unit/medical group experience in utilization review, insurance contracts, multi-payer inpatient authorization systems and/or business office operations is required, or 2+ years experience as a Licensed Vocational Nurse.
• AA Degree and/or healthcare related certificate course preferred.

Pay Range

$24.01/hour - $34.81/hour

Benefits

Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more… Check out our MemorialCare Benefits for more information about our Benefits and Rewards.