[Hiring] Utilization Review & Reimbursement Specialist @Mary Free Bed Rehabilitation Hospital

Role Description

Responsible for coordinating the Medical Record/Utilization Management Policies and Procedures according to standards set by the Hospital, Mary Free Bed Medical Staff, and outside regulatory agencies. This includes the analysis of medical records for documentation justifying the need for post-acute care services. This position works across the Mary Free Bed network of hospitals to provide insurance authorization services, and extended stay reviews and recommendations to provide access to inpatient rehabilitation when appropriate. The Utilization Review/Reimbursement Specialist is responsible for driving denial management strategies to ensure all appropriate patients have access to Mary Free Bed inpatient programs.

• Coordinates utilization management review functions as set forth in the Hospital Utilization Review Plan (screening for determination of necessity, eligibility, and appropriateness) at preadmission, admission, continued stay and discharge.
• Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.
• Manages the completion of prior authorization/recertification calls or faxes to a variety of third-party insurers as a part of the reimbursement process.
• Conducts complex case reviews for determination of inpatient admission criteria.
• Implements strategies to navigate insurance authorization process efficiently.
• Responsible for robust data capture through documentation of denial management activities and outcomes.
• Assists manager in the following areas:
  • Departmental and hospital-wide educational activities.
  • Review and refinement of Utilization Review policies and procedures.
  • Medical chart review and composition of insurance appeal letters on behalf of patients.
• Develops and maintains relationships with key payers to improve access to inpatient services at Mary Free Bed.
• Admission office duties as assigned by the supervisor.

Qualifications

• Degree in nursing, social work, physical therapy, occupational therapy, speech therapy, athletic trainer, or equivalent degree.
• Valid driver’s license with no restrictions.
• Demonstrated competence in spelling, grammar, and composition and able to type accurately.
• Ability to interact with professional staff in an appropriate manner.
• Demonstrated competence in the use of a personal computer for development and use of appropriate Medical Records, Admissions, and Utilization Management applications.

Requirements

• A minimum of 2 years’ experience in Utilization Management (preferred).
• Certification as a Registered Health Information Technician or Registered Health Information Administrator a plus (preferred).

Benefits

Compensation based on experience, starting from $28.70.

Company Description

Mary Free Bed is a not-for-profit, nationally accredited rehabilitation hospital serving thousands of children and adults each year through inpatient, outpatient, sub-acute rehabilitation, orthotics and prosthetics and home and community programs. With the most comprehensive rehabilitation services in Michigan and an exclusive focus on rehabilitation, Mary Free Bed physicians, nurses and therapists help our patients achieve outstanding clinical outcomes. The growing Mary Free Bed Network provides patients throughout the state with access to our unique standard of care.