Utilization Management Assistant

About This Role

This role involves performing data entry for online authorizations, obtaining authorizations from third-party payers, and interacting with them to provide patient information. The assistant also schedules physician 'Peer to Peer' review meetings and manages various aspects of authorization processes to support utilization management.

Responsibilities

• Data entry of clinical review information for online authorizations into multiple web sites for multiple payers
• Maintain accuracy of payer grid by notifying appropriate staff and Revenue Cycle of changes
• Obtain authorization for services from third party payers and notify RN Case Manager of issues
• Enter authorization numbers and approval days/dates into appropriate software systems
• Fax clinical reviews to payers, maintain confirmations, and document activities
• Interact with payers during phone conversations, providing discharge dates and patient status information
• Respond to email from Billing Department with requests for authorization numbers or patient status
• Answer departmental phones/messages and distribute to RN Case Managers
• Assist in obtaining authorization for inpatient and observation care by providing clinical information via fax, autoroute, and web-based programs
• Demonstrate ability to use multiple computer programs to research patient information

Requirements

• High School Diploma or GED
• Minimum 3 years of experience
• Analytical skills to assess urgency and complexity of workflow
• Proficiency in medical terminology
• Proficiency in use of computer technology and Microsoft Office software applications
• Strong interpersonal communication skills, including problem solving and decision making
• Demonstrated telephone communication skills
• Experience in a health care environment
• Ability to work well with physicians and other health care providers
• Strong customer service and ability to work in a team environment

Qualifications

• High School Diploma or GED
• Minimum 3 years of experience in a health care environment

Nice to Have

• Knowledge of UR processes and different levels of care within a hospital
• Knowledge of the University of Michigan Hospitals and Health Systems computer software systems
• Knowledge of the University of Michigan Hospitals and Health Systems Policies and Procedures

Skills

* Required skills

Benefits