Utilization Management Assistant

Major Responsibilities:

• Manage incoming fax, phone, and portal communications or any other requests from internal and external customers pertaining to clinical requests, approvals, authorizations, and denials; determine action required, and document all activities performed accurately and clearly in the designated database/area(s) of EHR.
• Communicate clinical needs, authorizations, and denials to the Utilization Review Nurses and Managers for follow up
• Verify insurance information provided by callers, fax, or Portal and send information to payers as requested, including discharge dates and disposition or clinical reviews/summaries prepared by UM RNs (if directed to do), while ensuring that all actions taken align/comply with the confidentiality and HIPAA compliance guidelines
• Follow up with payers to validate the authorization and confirm the days approved, and capture approved days in the EHR
• Enter data into database, spreadsheets, and perform analysis as directed. Provide efficient, courteous, and expert customer service to all internal and external callers. Open, sort, and process incoming mail/correspondence directed to the Utilization Review. Maintain the department records and files.
• Ensure provider compliance with Patient Status Admit Order (PSAO) co-signatures across the hospital sites covered by centralized UM.
• Utilize standard reports/patient lists withing the EHR to identify PSAO co-signature delinquencies and follow up with reminders/escalations to physicians to sign admission orders
• Follow the standard process to notify treating physician via perfect serve or other approved/designated methods of communication.
• Interact with Site and System Physician Advisors based on guidelines for escalation. Document all actions taken and status updates in the EHR.
• Maintain PSAO spreadsheet to track signature requests. Provide support and instruction to physicians to assist in the LOC order signature process.

Education/Experience Required:

• Level of Education:
• Four + years secretarial experience and High School Graduate or equivalent or
• Associates Degree Years of Experience: 2+ years of secretarial experience –preferably in a medical environment

Knowledge, Skills & Abilities Required:

• Competent in advanced functions with Microsoft Outlook, Word, Power Point, Excel and complete basic reporting Type 55+ words per minute.
• Strong critical thinking and communication skills to problem solve, and interact with colleagues, physician and payers.
• Ability to foster and maintain effective professional relationships, manage conflict while demonstrating Advocate Aurora’s Behaviors of Excellence at all times.
• Ability to be flexible and function well in a fast paced, continually changing environment.
• Assume responsibility for self-development by seeking out opportunities for growth and be an active participant in department, site and system initiatives.
• Comply with strict adherence to predetermined procedures and processes, safety, compliance and privacy/HIPAA guidelines.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.