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

Role Description

The Utilization Review/Reimbursement Specialist is 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.
• 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.

We’ll embrace all people by:

• Treating everyone with dignity and respect.
• Opening more doors to opportunity for others to succeed.
• Growing talent and people.
• Ensuring a welcoming experience for all we serve, regardless of origin, race, religion, disability, sexual orientation or socioeconomic status.
• Taking action against discrimination.
• Honoring our differences and how we collaborate.
• Educating staff, patients and the communities we care for.
• Restoring hope and freedom, together.

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 Range: $28.70 and goes up based on experience.
• Hours: Monday - Friday 8:30am - 5pm, Weekend rotation every 6-7 weeks.

Physical Requirements for Essential Job Qualification

• Remain in a stationary position: Majority.
• Traverse or move around work location: Occasionally.
• Use keyboard: Frequently.
• Transport, position, and/or exert force:
  • Up to 10 pounds: Occasionally.
  • Up to 25 pounds: _____.
  • Up to 50 pounds: _____.
  • Up to 75 pounds: _____.
  • More than 100 pounds: _____.
  • Other weight: Up to___ pounds: _____.

Consistent with the Americans with Disabilities Act (ADA), it is the policy of Mary Free Bed Rehabilitation Hospital to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Talent Acquisition team at [email protected].

Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, genetic information, veteran status, disability or other legally protected characteristic.