Utilization Review Assistant - M-F (8a-4:30p) - North Fulton

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

About the Role

The Utilization Review Assistant supports the UM Nursing department systemwide with non-clinical duties, tasks, and functions within the department to ensure these duties are performed timely. This role involves general clerical work and support duties including workflow maintenance, payer authorization processes, electronic filing, data entry, correspondence preparation, document processing, schedule management, multi-line phone systems, scanning, faxing, copying, and non-clinical EPIC documentation related to obtaining authorizations. The Utilization Review Assistant will assist the UM Nursing team to close EPIC cases requiring non-clinical interventions. Training is available.

Responsibilities

• Assessment / Clerical Support
  • Answer multi-line incoming phone calls, forward calls as appropriate, and review voicemail boxes hourly.
  • Produce, distribute, receive, review, and process all faxes per protocol.
  • Develop and maintain electronic files for incoming communications and disseminate as appropriate.
  • Research and create presentations as needed.
  • Communicate with appropriate UM Nursing team members related to departmental duties.
  • Prepare and monitor invoices as needed.
  • Handle all confidential information in a professional manner.
  • Take minutes for departmental staff meetings.
  • Monitor compliance with Medicare/Medicaid regulations, including delivery of MOONs and associated mailing.
• EPIC Workflow/Disposition Planning
  • Support the UM Nursing team with assigned functions in EPIC work queue space related to obtaining timely authorization information and coordinate with the UM Nursing team.
  • Escalate denial information received immediately to the UM Nursing team.
  • Develop and maintain a contact list.
  • Understand eligibility processes and criteria for both private and government payers. Place calls to payers to update and document authorization information in a timely manner.
  • Search payer web portals to update and document authorization information in a timely manner.
  • Generate EPIC and other reports as needed.
• Documentation
  • Document all attempts made to obtain authorizations by phone, fax, or web portal.
  • Document receipt of all incoming calls, faxes, or other communicated information related to Centralized UM department activities.
  • Document escalation of all denial-related communications to the UM Nursing team in a timely manner.
  • Communicate steps taken and determinations provided by insurance payers/web portals in a timely manner.
  • Document authorizations obtained in the Electronic Health Record.
  • Document efforts made regarding reconsideration efforts with all denials when received.
  • Provide sufficient and appropriate documentation required by GAMMIS for Medicaid pre-cert approvals on the GAMMIS portal.
• Professional Development and Initiative
  • Complete all initial and ongoing professional competency assessments, required mandatory education, and population-specific education.
  • Develop administrative support staff by providing information, educational opportunities, and experiential growth opportunities.
  • Perform other duties as assigned.
  • Comply with all WellStar Health System policies, standards of work, and code of conduct.

Requirements

• High School Graduate or equivalent.
• Minimum 3 years of experience working with customers/clients and a strong clerical background.
• Strong computer skills and proficiency in Microsoft Office products (Word, Excel, PowerPoint, Outlook).
• Hospital and/or medical front and/or back office background preferred.

Skills

• Excellent time management skills and proven ability to multi-task and prioritize work.
• Strong attention to detail and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to interact appropriately with stakeholders from various departments.
• Ability to work autonomously.
• Strong ability to build and sustain trust with the entire team.

Schedule

Day shift