Job Description
Overview:
Schedule:
M-F (Day Shift) Job Description Summary:
Provides administrative support to the Utilization Review Team and assists with eligibility verification, data entry, and coordination of information. Job Description:
Essential Functions:
Coordinates with external healthcare providers, payors, patients, and internal teams to obtain and provide necessary account information. Serves as a liaison for inquiries and issues regarding authorizations, denials, and utilization reviews. Manages incoming and outgoing telephones, emails, and faxes. Monitors and completes multiple work queues. Maintains accurate and complete documentation of admission authorizations and other utilization review information. Reports utilization review progress to leadership and ensures compliance with contractual standards and regulations. Participates in quality improvement initiatives to enhance utilization review processes. Education Requirement:
High School Diploma or equivalent, required. Associate's Degree, preferred. Licensure Requirement:
(not specified) Certifications:
(not specified) Skills:
Working knowledge of medical terminology, general medical office procedures, and HIPAA regulations. Experience:
One year of experience in hospital setting or medical office, required. Experience with CPT, ICD-10 and HCPCS coding, preferred. Two years of managed care experience including experience in a call center, preferred. Physical Requirements:
OCCASIONALLY
Lifting / Carrying:
0-10 lbs, Lifting / Carrying:
11-20 lbs, Machinery, Pushing / Pulling:
0-25 lbs, Standing FREQUENTLY
Color vision, Flexing/extending of neck, Interpreting Data, Reaching above shoulder, Repetitive hand/arm use, Walking CONTINUOUSLY
Audible speech, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Peripheral vision, Problem solving, Seeing - Far/near, Sitting Additional Physical Requirements performed but not listed above: Talking on the phone/in person Constantly "The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet" The moment you walk through our doors, you feel it. When you meet our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it. Welcome to Nationwide Children's Hospital, Where Passion Meets Purpose. Here, Diversity, Equity and Inclusion are integrated into our core values and practices. We are passionate about building, sustaining and evolving an inclusive and equitable environment. We are seeking individuals who live these values and want to share their experiences and efforts in support of our collective mission. We're 15,000 strong. And it takes every one of us to improve the lives of the kids we care for, and the kids around the world we'll never meet. Kids who live healthier, fuller lives because of the knowledge we share. We know it takes a Collaborative Culture to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere. Ask anyone with a Nationwide Children's badge what they do for a living. They'll tell you it's More Than a Job. It's a calling. It's a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere. Nationwide Children's Hospital. A Place to Be Proud.
