UTILIZATION REVIEW ASSISTANT
Baltimore-MD-21201-United States
JOB SUMMARY: The Utilization Review Assistant is responsible for performing administrative and operational functions needed for the Utilization Review Department of Care Management and ensures excellent communication with third-party payors and internal revenue cycle partners.
*This is a partially remote position and will be scheduled weekly for 3-10 hour shifts, 1-8 hour shift and rotating 2 hours on the weekend.*
RESPONSIBILITIES: Efficiently and effectively assists with the daily operations for the Utilization Review functions of Sinai Hospital of Baltimore. Communicates relevant information effectively to healthcare team, third party payers and internal revenue cycle partners. Manages payor calls and facilitates communication between payors and UR nurses. Faxes clinical reviews and updates to insurance companies when needed. Maintains, updates, and files insurance lists. Maintains logs for insurance, denials and appeals. Maintains Utilization and Appeals filing system. Accesses online payor portals for authorizations and denials and letters. Completes Livanta appeals. Receive Notice of Eligibility and logs information. Upload clinical information to Telligen/ Qualitrac. Performs data system entry and reporting daily. Back-up to the Care Management Administrative Assistant the following duties will be assigned: Organizes day to day departmental functions and acts as a care management departmental resource. Notifies leadership of operational problems. Maintains copies of letters sent to the patient and physicians in the Care Management Drive.
REQUIREMENTS:
- Formal working knowledge: equivalent to an Associate's degree (2 years college) preferred
- 1-3 years of administrative experience required
PI273662728
