Job title: Utilization Review Coordinator (Remote)
Company: Cincinnati Children’s Hospital Medical Center
Job description: Starting Pay: $20-24/hrDepartment: Utilization ReviewShift: Day Shift Remote (Must live within 50 miles of Cincinnati)About: Utilization review uses managed care techniques such as prior authorization that allow payers, particularly health insurance companies to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.RESPONSIBILITIESUtilization Review SupportProvides support to employees or groups in and outside of the organization related to Utilization review activities. Uses business software applications to prepare meeting minutes. Receives, screens and directs incoming calls, visitors, mail and email. Maintains files. Follows up on billing, determines and applies appropriate adjustments, answers inquiries and updates accounts as necessary.Pre-Authorization
Utilize systems including medical records to obtain needed clinical support to efficiently confirm receipt of or to obtain pre-authorization for scheduled services. Collaborate with internal and external resources regarding specific authorizations scenarios.Problem Resolution
Initiate calls to appropriate parties both internal and external to resolve issues. Escalate to appropriate staff regarding system errors, recurring divisional problems/errors identified within work queues or reports.Collaboration
Serve as a liaison between Hospital/Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patient Financial Services, and other Cincinnati Children’s departments.Productivity
Work independently and/or collaboratively with team to efficiently handle work volume and queues to meet or exceed productivity standards. Accurately collect/verify insurance information and demographics, obtaining insurance authorization and entering the information into the required systems. Follow up and documentation of outcomes of retrospective reviews and appeal cases.Coordination
Produce well written notes, documents, or communications. Take meeting minutes and format for final review. Work with outside vendors. Maintain office supplies.Communication
Researches information following well-defined paths and responds to a multitude of requests. Functions as a resource on department policy and processes. Works effectively with other departments, external agencies, and vendors. Troubleshoots in response to problems and poses solutions.QualificationsRequired:
- High school diploma or equivalent
- 2 years of work experience in a related job discipline
Preferred:
- Prior Authorization, Insurance, and Administrative Support experience
Cincinnati Children’s is proud to be an Equal Opportunity Employer that values and treasures Diversity, Equity, and Inclusion. We are committed to creating an environment of dignity and respect for all our employees, patients, and families (EEO/AA).
Expected salary: $20 – 24 per hour
Location: Ohio
Job date: Wed, 14 Aug 2024 02:00:40 GMT
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