Administrative Coordinator - Utilization Management

Provides direct support to the Utilization Management team and workflow which directly impacts revenue for Carilion Medical Center and all Carilion regional facilities.

• Serves as a resource for UM Director, Managers, nurse reviewers and fellow team members. Collaborates with members of the UM and/or Care Management team to assist in meeting timely patient progression/ throughput needs. 
• Prioritizes and performs UM Coordinator duties to maintain workflow functions as primary responsibility or as back up and as applicable to the department. Monitors workflow/processes and relays recommendations for improvement to UM leadership.
• Gathers required clinical and demographic data for UM and Appeals cases and disseminates to appropriate recipients. 
• Maintains databases and spreadsheet files, ensuring accuracy, production and distribution. Keeps files and reports in a confidential manner.
• Manages Epic work queues with appeals, denials and P2P data and tracks related data
• Serves as a resource/liaison with regard to payors, billing, Care Management staff, providers and outside vendors. Fields phone calls, voicemails and written correspondences via fax/email/inbox/USPS mail regarding benefits, coverage, insurance questions.  Disseminates these to appropriate UM Reviewer and documents actions taken.
• Arranges Peer-to-Peer (P2P) conversations between providers and payor liaisons.
• Aids in completion of federally mandated letters.
• On front line of appeals process, will be responsible for communicating with payors, Carilion billing department and UM Reviewers for appeals case submission.
• Forwards appeal referrals to outside vendor for protected release of information (ROI) and submits appeals electronically to payor portals. May require manual faxing and/or mailing of requested clinical information with appropriate ROI documentation.
• Maintains competence through continuing education, in-services, and attendance at staff meetings.  Performs other tasks related to the department workflow and participates in special department projects as assigned by the UM leadership team

Education: Associate degree or equivalent combination of education or equivalent 4 years of experience required.
Experience: Two years experience in data collection and analysis and/or advanced secretarial support required. Experience in emergency services or physician practice setting preferred.
Other Minimum Qualifications: Advanced computer skills with knowledge of a variety of software programs, including Microsoft word, Excel, Access, word processing, spreadsheets and presentation or database software. Excellent communications and organizational skills required.

This is Carilion Clinic ...
An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.
Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.
Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.