The coordinator assists in administering Utilization Management functions by organizing workflow, communicating internally and externally, tracking information, and creating reports, primarily supporting operations and payer communication to gain admission approvals through clinical review and appeals.
Requirements summary
A High School Diploma or GED is required, and candidates should possess at least one year of clerical support experience, with a preference for one year of administrative support experience in a healthcare field like case management or utilization review.
high schoolassociate degreeHIPAA ComplianceEMR DocumentationReport CreationProductivity StandardsWorkflow PrioritizationEPICExternal CommunicationClinical ReviewUtilization ManagementPayer RequirementsInternal CommunicationFax HandlingInformation TrackingAppeal ProcessesDenial DocumentationPeer To Peer Activity
Job description
Overview
Looking to be part of something more meaningful?
At HonorHealth, you’ll be part of a team, creating a multi-dimensional care experience for our patients.
You’ll have opportunities to make a difference.
From our Ambassador Movement to our robust training and development programs, you can select where and how you want to make an impact.
HonorHealth offers a diverse benefits portfolio for our full-time and part-time team members designed to help you and your family live your best lives.
Visit honorhealth.com/benefits to learn more.
Join us.
Let’s go beyond expectations and transform healthcare together.
HonorHealth is one of Arizona’s largest nonprofit healthcare systems, serving a population of five million people in the greater Phoenix metropolitan area.
The comprehensive network encompasses six acute-care hospitals, an extensive medical group with primary, specialty and urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, community services and more.
With nearly 17,000 team members, 3,700 affiliated providers and close to 2,000 volunteers dedicated to providing high quality care, HonorHealth strives to go beyond the expectations of a traditional healthcare system to improve the health and well-being of communities across Arizona.
Learn more at HonorHealth.com.
Responsibilities
Job Summary Under the direction of the Network Manager for Utilization Management, assists in the administration of Utilization Management functions to include, but not limited to, organization and prioritization of workflow, internal and external department communications, critical information interpretation and tracking follow up, research, and report creation.
The position primarily supports UM operations and communication with payers, in order to effectively gain approval of admissions via the clinical review and appeal processes.
Secondarily, this position supports Care Coordination department efforts in optimizing department communications from payers, in an efficient and effective workflow process.
Ensures all inbound faxes are handled timely and appropriately based on payer requirements.
Ensures approvals are in alignment with current patient class and escalates any received payer communication contrary to such.
Communicates with related Network departments in the event of account discrepancies concerning payer coverage and/or admission notification issues.
Documents EMR/EPIC appropriately according to department standards.
Collaborates and communicates with UM nurses regarding payer requirements for clinical documentation in order to secure appropriate level of authorization for the inpatient or observation admission.
Identifies, interprets, and initiates concurrent denial documentation and operational workflows, to include the scheduling of Physician Advisor peer-to-peer activity with payers.
Essential Functions Performs a variety of routine clerical and revenue optimizing activities according to department workflows.
Meets defined productivity standards.
Works accounts from assigned WQs.
Monitors RightFax daily for inbound faxes from payers.
Renames inbound faxes, adhering to department naming conventions.
Uploads payer approvals, bed days and denials to appropriate patient’s account.
Documents EMR/EPIC Auth/Cert and Communications.
Faxes initial or continued stay clinicals to payers utilizing appropriate method ensuring payer requirements are met.
Follows up on fax fails until successfully resolved.
When HIPPA breaches occur, fills out Compliance department breach reporting form and submits chart correction.
Communicates with Preservices team if patient’s coverage is termed or unclear.
Continuously monitors deferred accounts; follows up timely with payers to obtain additional approved days.
Collaborates with external payers in securing approvals, as well as internal team members, UM nurses and others in Care Coordination departments to achieve business needs of the department and in support of revenue optimization.
In all areas of responsibility, communicates barriers and escalates issues.
Facilitates clinical data requests and documents appropriately.
Coordinates concurrent denial resolution with nursing and physician advisor team.
Facilitates peer to peer review with payer as directed.
Retrieves utilization management clinical requests and handles each appropriately according to department standards.
Escalates patient calls to leadership and documents in EPIC/EMR.
Performs other duties as assigned (reports, research, meeting scribe, new hire onboarding, etc.) Education Associate's Degree - Preferred High School Diploma or GED - Required Experience 1 year Clerical support - Required 1 year Administrative support in a healthcare field (e.g., case management, utilization review, medical insurance, medical office front desk, hospital business office, preservices, admitting, registration, billing, collections) - Preferred Licenses and Certifications
