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AtlantiCare · 3 months ago

Utilization Management Administrative Support Staff - Airport Commerce - Part Time

Egg Harbor Twp, NJ, 08234, United States

Full-time, Part-time

Onsite

Mid Level

3+ years exp

AtlantiCare is a healthcare organization seeking a Utilization Management Administrative Support Staff. This role provides administrative coordination to the Utilization Management staff and Revenue Integrity Team, focusing on obtaining and validating authorizations for patients' hospital stays to prevent denied claims.

CRMFitnessHealth CareInformation Technology

Responsibilities

Assisting the Utilization Review RN, Physician Advisor, Revenue Integrity Team and HIM records release to obtain/validate authorization from the payers for the patients’ hospital stays at the appropriate level of care

Assisting in Veracity denials portal to coordinate dispute/appeals for non-paid accounts

Accessing all payer portal timely, denied and approved accounts

Faxing clinical information to the payers and transferring details into MCCM and MMX system for approvals and denials

Daily monitoring of various payer portals and submitting the requested information as directed by Utilization Review Coordinators

Providing prompt feedback to both the Utilization Review Coordinators and the Physician Advisor if an authorization is not obtained

Establishing peer to peer with PA and payor and documenting the various payer communications in the Care Management Tool

Qualification

Medical TerminologyPayer Authorization ProcessesPayer Portal UseExcel ExpertiseEffective CommunicationOrganizational SkillsTime ManagementFlexibility

Required

Associate's Degree required or High School Diploma with 3 years relevant experience

Minimum 3 years of relevant experience required, with demonstrated acumen in Medical Terminology and payer authorization processes, payer portal use and access

Strong effective communication skills

Excellent organizational and time management skills

Flexibility in responding to multiple demands