Utilization Assistant - FT - HPW

Work Shift:

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Position Overview:

Utilization Assistant

JOB CODE:50219

FLSA Exemption Status:Non-Exempt

SUMMARY (BASIC PURPOSE OF THE JOB)

Works as a member of the multidisciplinary team to provide support for the utilization and denial process. Performs follow-up tasks identified by the Utilization and Denial team to enhance the management of cases and the departments’ processes. Supports the Utilization, Denial and Resource Management Department operations and assists with task to promote positive, timely, cost effective outcomes.

MINIMUM REQUIREMENTS

Education: High school diploma or GED.

Experience: Two years related office experience.

Knowledge and Skills:Knowledge of Word, Excel, and PowerPoint. Must be able to work independently and possess excellent verbal and written communication skills. The Utilization assistant must have the ability to function as a team member and appropriately seek supervision as needed.

Special Training:

Mental, Behavioral and Emotional Abilities:Demonstrates the ability to organize and prioritize responsibilities and has the ability to interact with all levels of staff in a courteous and professional manner. Must be willing and able to travel between campuses.

Usual Work Day:8 Hours  

REPORTING RELATIONSHIPS

Does this position formally supervise employees? No

If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

ESSENTIAL FUNCTIONS

• Maintains, on a timely and accurate basis, records and databases of information specific to the department, often of a highly confidential nature. Maintains confidential personnel files for department staff, processes time sheets, and tracks PTO in accordance with policy and procedure, serves as liaison with Payroll and Human Resources.
• Collaborates with the Utilization nurses by preparing the Medicare MOON forms for patients and assures the accuracy of the form.
• Provides services to utilization and denials management customer base including receptionist activities, troubleshooting, and problem resolution. Provides additional information to customers in accordance with department and CH policies, practices, and procedures.
• Coordinates all office activities such as maintaining accurate filing systems, ordering supplies, requesting maintenance and housekeeping services, scheduling appointments, opening and distributing mail, preparing and distributing correspondence, creating daily reports, and setting up meetings.
• Assists in issuing the Medicare MOON form to patients and communicates the Medicare Rights to patients and family members if applicable.
• Maintains calendars for the Department Head with accuracy, updating as changes occur. Schedules meetings and coordinates meeting arrangements, including facilities, catering, and logistics assuring smooth functioning of events. Makes travel arrangements as needed.
• Coordinates the timely and accurate receipt, processing, production, and distribution of regular reports to appropriate department staff.
• Enters all denial information received through mail or other correspondence in the appropriate area in the case management system timely and accurately. Maintains accurate records of all denial and appeal activity by following the department workflow for the handling of denials and appeals. Refers all denial and appeal correspondence to appropriate parties for review and response. Follows up for completion and maintains statistics on denial and appeal activity.
• Maintain accurate documentation of correspondence and calls in the utilization management software system.
• Performs a variety of clerical tasks: monitors and orders office supplies, makes copies, and sends and receives faxes as required.
• Monitors and reports on the daily Observation and Outpatient in a bed census.
• Organizes and maintains department files and paperwork and ensures that all materials are filed accurately and in a timely manner. Maintains confidentiality of information.
• Assists with special programs including data collection for process improvement projects.
• Uploads appeal letters and appeal responses and monitors timeliness of appeals.
• Assists the nurses with Utilization Management incompletes by using the payer portals to obtain determinations.
• Performs other duties as assigned.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

Frequent physical demands include: Sitting , Standing , Keyboard use/repetitive motion , Talk or Hear
Occasional physical demands include: Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor activities
Continuous physical demands include:
Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.
Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing

Anticipated Occupational Exposure Risks Include the following: Bloodborne Pathogens , Chemical , Airborne Communicable Disease

Offers are contingent upon successful completion of our onboarding process and pre-employment physical.  Capital Health will require all applicants to have an annual flu vaccine prior to start date, with the exception of individuals with medical and religious exemptions.