Utilization Management Assistant

Essential Duties:

• Data entry of clinical review information for online authorizations into multiple web sites for multiple payers
• Maintain accuracy of payer grid by notifying appropriate staff and Revenue Cycle of changes in fax numbers, etc.
• Obtain authorization for services from third party payers and notify RN Case Manager of issues with authorizations
• Enter authorization numbers and approval days/dates into the appropriate software system for utilization management and electronic medical records.
• Fax clinical reviews to payers, maintain confirmations, document completely and accurately activities performed
• Interact with payers during phone conversations, provide discharge dates and patient status information
• Respond to email from Billing Department with requests for authorization numbers or patient status
• Answer departmental phones/messages and distribute to RN Case Managers mindful of coverage assignments.
• Assist in obtaining authorization for inpatient and observation care by providing payers with clinical information via fax, autoroute, and web-based programs, for example, E-Referral, Navinet, Pnote
• Demonstrate ability to use multiple computer programs to research patient information
• Willingly and consistently offer assistance to staff especially when patient census is high
• Actively participate in learning new technologies
• Provide notification to out of state insurers when requested by case managers
• Other duties as assigned

Daily Work Duties:

• Insurance Alert Changes from software system for utilization management: notify RN CM if additional clinicals are required
• For web-based programs, for example, P Notes for Blue Cross PPO and Traditional and E Referral for Blue Cross Network (BCN), input patient data, submit initial review with InterQual criteria subset (1511 work queue)
• Utilize Accuroute a software fax program effectively
• Authorizations/Certifications – obtained by phone calls, faxes, payer contact screen
• Combining Admissions – documenting in MiChart, submit codes for billing
• Telephone notification of out of state insurers, providing ICD codes (clinical follows)
• Navinet – Online portal to start process for Aetna, Cigna, BC Complete, Amerihealth, Priority to obtain authorizations and check for updates
• General faxing
• DCPA – authorizations pended, discharge information required
• 223 List in MiChart to complete input of auths/certs
• Follow up on emails from professional billers by editing patient information in the utilization management software.
• Distribution of cases on the unassigned worklist

Qualifications:

• High School Diploma or GED.
• An Associate's degree in social sciences or other related field or an equivalent combination of education and experience is necessary
• Minimum 3 years of experience.
• Analytical skills are necessary in order to assess urgency and complexity of workflow
• Proficiency in medical terminology
• Proficiency in use of computer technology and experience with Microsoft Office software applications
• Strong interpersonal communication skills, including problem solving and decision making
• Demonstrated telephone communication skills required
• Experience in a health care environment
• Ability to work well with physicians and other health care providers
• Strong customer service and ability to work in a team environment

Preferred Qualifications:

• Knowledge of UR processes and different levels of care within a hospital
• Knowledge of the University of Michigan Hospitals and Health Systems computer software systems
• Knowledge of the University of Michigan Hospitals and Health Systems Policies and Procedures

Work Schedule:

Work schedule varies. Monday through Friday with some weekend and holiday coverage. Hours are 9:00am to 5:30pm