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Utilization Mgmt Spec

Company: Beaumont Hospital, Royal Oak (Mich.)
Location: Royal Oak
Posted on: November 21, 2022

Job Description:

GENERAL SUMMARY:

Under general direction, assists in the provision of the highest service level possible to patients/customers to ensure their satisfaction. Participates in activities with third party payors in order to maximize reimbursement.

ESSENTIAL DUTIES:

1. Understands and accesses insurance websites. Completes required duties as defined for specific payers to obtain authorization numbers for payment.

2. Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with outpatient or inpatient status.

3. Utilizes electronic medical record work queues that support Utilization Management functions.

4. Answers incoming calls or places outbound calls with appropriate communication skills. Triages all calls to the appropriate person for resolution and action or completes appropriate follow-up.

5. Problem solves issues that are received via phone, fax or email.

6. Other duties as assigned.

This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described.

STANDARD QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

A. Education / Training:

High School Diploma or G.E.D. completion required. Post high school training and/or academic coursework leading toward associate's or bachelor's degree preferred.

B. Work Experience:

Two years of healthcare experience preferred.

C. Certification, Licensure, Registration:

None

D. Other Qualifications:

Competency and comprehension of basic medical terminology. Well-developed computer skills and/or business related software/application literacy.

Keywords: Beaumont Hospital, Royal Oak (Mich.), Royal Oak , Utilization Mgmt Spec, Other , Royal Oak, Michigan

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