Position Summary/Essential Duties:

Collaborates and coordinates with all members of the health care team, patient and family (or significant others) to coordinate and ensure timely and efficient delivery of required workflow, services and tasks to result in:

• Support of positive patient health care outcomes
• Increased patient/health care team outcomes and satisfaction
• Improved inpatient throughput and appropriate length of stay
• Improved communication, awareness and adherence to regulatory requirements associated with utilization
• Support for inappropriate level of care and decreased inpatient bed day denials
• Continuity and coordination of care
• Appropriate and timely authorization for level of care
• Decreased denials
• Appropriate reimbursement

• Perform timely and accurate denial communications and activity; clarify communications as needed, and collect additional information in preparation for Nurse review.
• Support the denial/appeal management nurse in collaborating with physicians, UM Nurses, PAS, and other members of the Interdisciplinary team, Revenue Cycle and payers to collect and relay all pertinent information to support successful appeals.
• Document appeal activity according to department standards to support accurate reporting of denial and appeal status, outstanding revenue and to help identify trends (payer, physician, service, DRG, reviewer).
• Research and record appeals outcomes and produce reports related to denial and appeal outcomes.

• This role may encounter Protected Health Information (PHI) as part of regular responsibilities. UH employees must abide by all requirements to safely and securely maintain PHI for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Education:

• High School diploma or equivalent required.

Degree preferred

Experience & Knowledge:

• Minimum 3 years of hospital or physician office billing or Utilization Management/Case Management department experience required.

Experience in managed care preferred.

Special Skills & Equipment Knowledge:

• Must be detail-oriented and organized, with good analytical and problem solving ability.
• Notable client service, communication, presentation and relationship building skills required.
• Ability to function independently and as a team player in a fast-paced environment required.
• Must have strong written and verbal communication skills.
• Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.) required.
• Strong typing skills required.

Medical Terminology.