What are the responsibilities and job description for the Utilization Tech I position at Resurrection Medical Center?
Overview:
Responsibilities:
Required qualifications:
1. High School Diploma or Equivalent.
Preferred qualifications:
1. Completion of a medical terminology course; preferred.
#LI-AS4
Resurrection Medical Center in Chicago, IL, is a critical care hospital and ER with advanced specialty care services. Resurrection delivers specialty care and 24/7 emergency care to Chicago's northwest side. We provide advanced surgical care for serious and life-threatening injuries and illnesses. Our care teams listen to understand your health needs and deliver care that's right for you. Resurrection is a destination for specialty care — including heart and vascular, breast health, neurology, stroke care, cancer care and women's health. Our OB-GYNs and maternity care teams deliver a personalized birthing experience and advanced neonatal care for sick babies. We offer a wide range of minimally invasive procedures using robotic-assisted technology, imaging and lab tests, a dedicated inpatient rehabilitation center, all on one campus.
Responsibilities:
The Utilization Review Tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives.
- Utilization review tech is responsible for coordinating phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals.
- Document and track all communication attempts with insurance providers and health plans and scan all related correspondence to the respective EMR/ tracking tool.
- Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers.
- The Utilization Review Tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned.
- The Utilization Review Tech will further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.
EDUCATION, EXPERIENCE, TRAINING
Required qualifications:
1. High School Diploma or Equivalent.
2. Microsoft office proficiency.
3. Good communication skills
Preferred qualifications:
1. Completion of a medical terminology course; preferred.
2. Knowledge of HIPAA regulations preferred.
#LI-AS4
