Permit review assistant job description

Daily responsibilities include account WQ's, processing faxes, denials, requests for clinical. Strong organizational skills a must in the fast paced environment

The Utilization Review Assistant is an integral part of the Regional Utilization Review department. They are the link between the insurance payers and the UR nurses as they monitor and manage denial/approval communication to ensure timely responses to payers, while mitigating the risk for hospital insurance payment denials.

Updates Do Not Bill (DNB) Bed Day Table WQ daily while maintaining Trinity and LM turnaround goal .20/Trinity 1.00 days/LM • Obtain authorizations and remaining certified days from payers to finalize bed day authorizations/denials. Responsible for closing out all documentation in Allscripts. Access insurance payer portals to review denials/approvals within appropriate turnaround time to minimize the likelihood of payment denials. Timely notification to the appropriate staff to ensure follow through with request if appropriate. Schedules P2P discussions with the payors and hospital physicians within the timeframe outlined by the insurance payer.

Interacts with FCC (Financial Clearance Center)colleagues, physician advisors, UR Nurses and leadership to ensure correct patient insurance is identified and right payer receives timely clinical documentation for insurance payment. Updates demographics, correct payer contact information to complete all authorizations for hospital admissions. Frequent daily communication with physician advisors, utilization review nurses, manager and hospital colleagues regarding status of administrative denials for medical necessity, lack of clinical and level of care.

Consistently monitors the phone and fax lines throughout the day to facilitate timely response to clinical requests from payers. Document all communication from our Quality Improvement Organization (QIO) in Allscripts and notify regional manager and team leads via email of request for patient appeal. •Maintain compliance with Workers Comp cases, verifying ROI before releasing clinical to 3rd party. Monitors fax to verify correct auth/fax information has been provided for both primary and secondary coverage. Confirms throughout the day there are no failed faxes to ensure communication reaches insurance payers. • UR Assistant will support the UR Nurses by calling insurance payer after the RN has been unsuccessful in acquiring authorization from the payer for hospital stay.

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Core Values, and Vision in behaviors, practices, policies and decisions. All other duties assigned.
Requirements:



Minimum Education:


Required: High School Diploma plus training acquired through work experience or education

Preferred: Associates Degree


Minimum Experience
:

Required: 3-5 years of previous job-related experience. Excellent organizational and communication skills, knowledge of Excel and keyboarding. Typing skills are a must


Our Commitment to Diversity and Inclusion


Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

Job Details

Level
Entry

Job Location
Main Hospital - Los Angeles, CA

Position Type
Part Time

Education Level
High School

Salary Range
$20.00 - $22.00

Job Shift
Day

Utilization Review Assistant

Utilization Review Assistant

Gateways Hospital & Mental Health Center

Exempt - Part Time

SUMMARY OF POSITION

The Utilization Review Assistant is responsible to monitor adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services. To monitor the appropriateness of hospital admissions and extended hospitals stays. Additional information available includes essential job functions, additional responsibilities, and education and experience requirements.

ESSENTIALS DUTIES

Monitors patient charts and records to evaluate care concurrent with the patient's treatment. Utilization Review Assistant reviews treatment plans, and status of approval for insurers. Collects and compiles data as required and according to applicable policies and regulations. Additionally, the UR Assistant consults with physicians as needed.

EXPERIENCE/QUALIFICATIONS

Satisfactory work experience for one (1) year, which demonstrates knowledge and skill in

a healthcare setting, preferable Acute Psychiatric Hospital.

EDUCATION & CERTIFICATES

Desired Education:

High School Diploma

Minimum Certification:

None

Licensure Required:

None

REQUIREMENTS

• Must pass Department of Justice (DOJ), Federal Bureau of Investigations (FBI), and Community Care Licensing (CCL) background clearance.
• Valid California Driver's license.
• TB clearance.
• Driving record acceptable for coverage by Gateways insurance carrier.
• Fire and Safety Training*.
• First Aid Training Certification*.
• CPR Certification*.
• Crisis Prevention Institute Training (CPI)**

* Note: If indicated certifications/licenses are lacking, they must be obtained within 180 days of hire.

**Training needs to be completed within 30 days from the date of hire on a designated date provided by on-boarding. Staff need to be certified at the commensurate level for their role to perform their job duties (staff will be taken off the schedule if certification is not achieved).


PHYSICAL REQUIREMENTS

• To perform this job you must be able to carry out all essential functions successfully. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the job.
• Employee will be required to lift and/or move unassisted up to 25 pounds.

Are you an experienced Review Assistant looking for a new challenge?

Do you value care management and quality improvement?

Are you motivated, energetic, and excited to become part of the Kepro team?

If so, you might be our next new team member!

Who we need:

The Review Assistant prepares medical records for clinical review to streamline the review process. Maintains working knowledge of internal policies, procedures and services (both departmental and operational.) Ensures productivity and quality standards are met for required contract deliverables. Prepares all related documents, mailings and reports to meet requirements for eligibility, services and hearings.

Why us?

Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.

People Focused. Mission Driven.

Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.

We do this through our people.

At Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career.

Benefits are a key component of your rewards package at Kepro. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.

What you'll do:

Reviews patient records and compares against submission requirements to determine if all required information is present for the case. Identifies cases where additional non-clinical information is needed.

Process and document medical record requests and other documents for clinical review

Accurate and timely submission of all administrative related documents to appropriate parties.

Foster positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building in order to facilitate the review process.

Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for case preparation.

Maintains medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, adherence to HIPAA polices.

Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following KEPRO's policies, procedures and guidelines

Cross-trains to perform duties of other contracts within the KEPRO network to provide a flexible workforce to meet client/consumer needs.

What you'll need:

Required Qualifications

Associate's Degree and/or equivalent work experiences related to medical, behavioral, or social/support settings.

Knowledge, Skills, Abilities

Knowledge of general review of records, claims or requests in a healthcare related field.

Knowledge the organization of medical records, medical terminology, disease process.

Ability to work in a team environment.

Ability to interpret complex documentation.

Ability to organize and present case information clearly and accurately.

Ability to work in a fast paced environment.

Excellent verbal and written communication skills essential.

Computer skills required with MS Word and Outlook and proprietary software.

Strong critical thinking skills necessary.

Flexibility and good organizational skills needed.

Experience

Medical terminology and/or claims experience helpful.

Working knowledge of software with healthcare or insurance application.

1-2 years of experience in administrative or records management.

QI/Utilization review experience helpful.

Thank You!

We know your time is valuable and we thank you in advance for applying for this position. Due to the high volume of applicants we receive, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Kepro and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Kepro Talent Acquisition Team

Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

EOE AA M/F/Vet/Disability

Kepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.