What are the responsibilities and job description for the Utilization Review Coordinator - Cancer Care & Research Center position at LAKE REGION HEALTHCARE?
Job Details
Description
The Utilization Review Coordinator is a critical member of the Cancer Care & Research Center (CCRC) team. The main focus of this position is to promptly address insurance appeals and denials, obtain prior authorization for oncology treatment and services, and to provide support to the Patient Financial Navigator. The Utilization Review Coordinator will also conduct audits of the patient chart to ensure insurance information and authorizations are current and aligned with the upcoming appointments to support seamless patient care delivery. The role requires collaboration with healthcare providers, insurance companies and other stakeholders to resolve reimbursement issues. The Utilization Review Coordinator is expected to identify denial trends and provide findings to leadership. This role with perform other duties as assigned.
This position reports to the CCRC Operations Manager.
Benefit Offerings:
Lake Region Healthcare is pleased to offer a comprehensive benefit program designed to meet your unique needs. This includes medical and dental coverage; HSA, FSA and 401k plans; EAP, life and disability coverage; voluntary accident, critical illness and hospital indemnity coverage; pet insurance, ID theft protection and legal services. For new employees, the effective date of coverage for most plans is the first of the month, following a 30-day waiting period.
EEOC:
Lake Region Healthcare provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Qualifications
Education:
- Required: High school diploma.
- Preferred: Associate degree in a healthcare field.
Preferred Experience:
- Experience obtaining authorizations, navigating insurance requirements, and processing denials and appeals in an outpatient oncology setting.
- Knowledge of medical terminology.
Job Requirements:
- Ability to provide empathetic support for patients and their family members.
- Ability to multi-task effectively in a fast-paced environment.
- Skilled in establishing priorities and managing competing demands.
- Demonstrate strong interpersonal and organizational skills to interact courteously and effectively with physicians, patients, and staff members.
- Ability to consistently interact with all members of the organization in ways that enhance understanding, respect, cooperation and problem solving.
- Skilled in responding quickly and accurately with patient needs and physician directions.
- Writing and editing skills to prepare grammatically routine business correspondence such as informal letters, memoranda, and notification letters.
- Skilled in operating a PC and PC-based software applications, including Microsoft Office suite.
- Understanding of insurance authorization process and appointment scheduling systems.
- Overall knowledge of the healthcare delivery system.
