Utilization Management Assistant

The CommonSpirit Utilization Management Assistant receives, processes, facilitates and documents all payer communications.  This position supports denial mitigation by sending documentation within the contracted time period, following up on accounts lacking authorization and communicating with internal stakeholders to ensure the accurate submission of clinical documentation to third party payers.  The Utilization Management Assistant supports the Utilization Management Hub department by recognizing trends and opportunities for process improvement and reporting those to leadership.  The Utilization Management Assistant performs these duties with a high degree of accuracy utilizing critical thinking skills and in compliance with hospital policies, standards of practice and Federal and State Regulations.

• Receives, sends and documents payer requests for clinical documentation.
• Receives and documents payer authorization and communications including but not limited to concurrent denials.
• Coordination of peer to peer conversations, as applicable.
• Reviews surgery schedule to verify correct authorization is documented, if applicable.
• Identifies accounts lacking authorization and follows up with payers, as needed.
• Communicates with interdepartmental staff regarding payer documentation requests.
• Under RN direction submits requests for and follows up on administrative days authorization, where indicated.
• Identifies and reports trends to department Leadership.
• Utilizes payer related reports from Care Management software, where applicable.
• Collaborates with and supports the UM team including but not limited to UR and Denials RN.
• Contributes to the identification of opportunities for process improvement.
• Supports administrative departmental functions, as assigned.

Required

• Minimum one year experience in a hospital, physician’s office, or medical group performing duties related to admitting, business office, payer communications or managed care or an equivalent combination of education and experience
• High school diploma or GED required

Preferred

An understanding of operations and functions of care coordination, Utilization Management, denials mitigation is preferred.