What are the responsibilities and job description for the Utilization Tech I position at Prime Healthcare?
Overview
Saint Francis Hospital in Evanston, IL, is a critical care hospital and ER with advanced specialty care services. Located along Chicago's North Shore, Saint Francis delivers specialty care and 24/7 emergency care. And, we have a level I adult trauma center. 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. Saint Francis is a destination for specialty care - including heart, cancer, stroke care, orthopedics and women's health. 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.
EDUCATION, EXPERIENCE, TRAINING
Required Qualifications
Saint Francis Hospital in Evanston, IL, is a critical care hospital and ER with advanced specialty care services. Located along Chicago's North Shore, Saint Francis delivers specialty care and 24/7 emergency care. And, we have a level I adult trauma center. 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. Saint Francis is a destination for specialty care - including heart, cancer, stroke care, orthopedics and women's health. 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
- High School Diploma or Equivalent.
- Microsoft office proficiency.
- Good communication skills
- Completion of a medical terminology course; preferred.
- Knowledge of HIPAA regulations preferred.
