Utilization Management Administrative Coordinator

We're seeking a Utilization Management (UM) Administrative Coordinator to join our team! In this posiiton, you'll work under the guidance of the Manager of Utilization Management and RN UM Specialists and will serve as a key role in supporting the affiliate-level Utilization Management and denials processes by coordinating incoming requests for information from multiple payer sources. While the role is multifaceted, the primary focus relates to financial risk mitigation and regulatory compliance.

The Coordinator will conduct maintenance and utilization of EPIC work queues that support obtaining authorization for patient stays. The Coordinator communicates with payers via telephone, fax, or email, and is responsible for ensuring clinical requests are sent in a timely manner and in a thorough fashion. The Coordinator is expected to acquire an understanding of third party authorizations, verification, and denials, and proceeds with notification/documentation to appropriate parties. Coordinator is also responsible for clerical/administrative support to Utilization Management nurses as assigned.

This position is open to remote/work from home with strong preference for candidates residing within the UPH geographies of Iowa, Illinois, & Wisconsin.

COVID-19 and Flu Vaccination Requirement: It is required to be fully vaccinated for COVID-19 and Influenza. Exemption requests based on medical or religious reasons may be submitted, but must be approved for active employment.

Why UnityPoint Health?

• Commitment to our Team – We’ve been named a  Top 150 Place to Work in Healthcare 2022  by Becker’s Healthcare for our commitment to our team members.
• Culture – At UnityPoint Health, you matter. Come for a fulfilling career and experience  a culture  guided by uncompromising values and unwavering belief in doing what's right for the people we serve.
• Benefits – Our competitive  Total Rewards  program offers benefits options that align with your needs and priorities, no matter what life stage you’re in.
• Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.
• Development – We believe equipping you with support and  development opportunities  is an essential part of delivering a remarkable employment experience.
• Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve.

Visit us at UnityPoint.org/careers to hear more from our team members about why UnityPoint Health is a great place to work.  https://dayinthelife.unitypoint.org/ 

• Coordinates and serves as primary point of contact for affiliate-level Utilization Management (UM) inquiries & requests for information from internal and external sources. Receives and documents UM requests including researching to determine appropriate action needed to complete request according to established processes. Seeks necessary clinical direction of RN UM Specialist staff or Manager.
• Coordinates appropriate and timely exchange of information with payers, UM nurses, Financial Clearance Team, and/or other internal users. Maintains current knowledgebase of payer requirements and contact information.
• Monitors and completes accounts on multiple work queues in EPIC, including referrals and denials.
• Monitors requests in work queue for clinical information. Prepares/faxes requested documentation for review to third party payers. Ensures receipt of documents. Documents sending of clinical information in patient chart in EPIC.
• Serves as primary point of contact for affiliate-level denial inquiries from internal and external sources under direction of the Manager.
• Coordinates and logs incoming affiliate-level denial requests. This includes performing research to determine appropriate action needed to complete request according to established processes.
• Maintains current knowledge of payer requirements and contact information.
• Coordinates denials with outside organizations used for Second Level Review (e.g. AppriseMD).
• Monitor/document third party payers approved days, denials, requests for further information.
• In coordination with RN Utilization Management Specialist, communicate opportunities for Peer to Peer from third party payers, with our physicians. Coordinate discussions between payer physician and UPH physician, as indicated. Document requests/results of Peer to Peer conversation.
• Maintains Denials Databases in an accurate and timely manner to support data analysis and reporting.

Education:

• Associates degree or above in related field or 2 years direct and applicable work experience.

Experience:

• Patient care experience/knowledge
• Customer Service or Administrative Support
• Written & verbal communication proficiency
• Preferred:
  • Insurance billing or claims processing
  • Experience working in databases

License(s) Certification(s):

• Valid driver’s license when driving any vehicle for work-related reasons.

Knowledge/Skills/Abilities:

• Microsoft Office proficiency (Outlook, Word, Excel)
• Customer/patient focused
• Ability to work with minimal supervision
• Ability to manage priorities/deadlines
• Excellent verbal and written communication skills
• Ability to multi-task and prioritize workload
• Flexible and adaptable to changing environment
• Excellent critical thinking and problem solving skills
• Preferred:
  • Experience with electronic health records
  • Experience with health care agencies and community resources
  • Knowledge of payer environment