This position assists in the administration of Utilization Management functions to include organization of workflow, communications with the system, critical information tracking and links with external payor representatives. This position is focused on supporting the role of utilization management process to protect the organizations financial goals. This position works closely with utilization review staff, insurance companies, patient financial services and central billing office.
Handles incoming requests for patient medical records, notifications of authorizations and denials and other related communications. Receives and verifies requests and external communications, initiates insurance verification, gathers and submits all information necessary for certifications for medical necessity. Provides on-going follow-up of requests, up to and following patient discharge.
Builds clinical response to external requests using information in patient medical record to provide minimum data necessary to coordinate authorizations. Follow up communication with insurance companies with information as required and documents responses for follow up as identified.
Performs data entry of patient intake information into computer system. Records insurance information and authorization requirements and notes information in the identified data entry systems.
Facilitates problem solving with hospitals, providers, referral sources, insurance companies, and clinical staff. Assists in the maintenance and communication of changing payor and referral source information specific to coordination of patient needs.
Ensures communications between payor and hospital occurs per payor request. This includes accurate transcription and routing of third party payor communications.
Abstracts information from patient medical records pertaining to patient identification, treatments, procedures and outcome as required by duties assigned. Documents accurately and timely in electronic record of insurance review activities and notifications of authorizations and denials.
Participates in departmental improvements, Banner initiatives and performs data collection for measurement of projects.
Works collaboratively with team members; promotes collaborative relationships with commercial payors and external customers.
High school diploma/GED or equivalent working knowledge.
The position requires a proficiency level typically achieved with 3 years experience in healthcare as a Nursing Asst, Medical Asst, Health Unit Coordinator, Patient Care Tech, etc.
Requires an understanding of medical terminology. Must demonstrate effective communication skills, human relations skills, strong organizational and time management skills and flexibility in responding to multiple demands.
Bilingual, preferred in some assignments.
Additional related education and/or experience preferred.
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.