Utilization Mgmt Support Specialist II

Sutter Health • Sacramento, CA

1d • $30 - $43

About The Position

Organization: S3-Sutter Shared Services-Valley Position Overview: Accumulates, processes, interprets, and documents timely payer information to justify acute hospital admission, need for continued stay, and proper level of care billing based on clinical outcomes. Responsible for processing concurrent and retrospective denials in collaboration with clinical utilization management staff and internal physician advisors. Under the direction of management, develops, coordinates and monitors systems for the appeal/denial process, tracks and trends data, and coordinates utilization management operations activities with leadership and key stakeholders. Collaborates with other departments. Monitors and acts as a liaison between leadership, external payers, staff, and other related services and departments to assist with troubleshooting, tracking, and trending the appropriate level of service, payer behavior, and identifying opportunities for improvement. Assists with assigned projects and participates in department meetings and team discussions. Adheres to all local, state, and federal regulations, codes of conduct, policies, and procedures to ensure privacy and safety while delivering optimal patient care.

Requirements

• Equivalent experience will be accepted in lieu of the required degree or diploma.
• HS Diploma or General Education Diploma (GED)
• 1 year of recent relevant experience
• Working knowledge of medical terminology, experience with medical insurance verification, payer reimbursement plans, revenue cycle processes.
• Knowledge of criteria required for payment processes.
• Ability to interpret a variety of data and instructions, furnished in written, oral, diagram, or schedule form.
• Possess written and verbal communications skills to communicate with fellow team members, supervisors, patients, and other personnel.
• Well-developed time management and organizational skills, including the ability to prioritize assignments and work within standardized policies and procedures to achieve objectives and meet deadlines, production and quality standards.
• Demonstrated knowledge of electronic health record and computer applications.
• Ability to work independently, as well as be part of the team, including accomplishing multiple tasks in an environment with interruptions.
• Ability to identify, evaluate and problem-solve by selecting appropriate solutions from established options before escalating to leadership.
• Ability to build collaborative relationships with peers and other internal/external customers to achieve departmental and enterprise objectives.

Responsibilities

• Accumulates, processes, interprets, and documents timely payer information to justify acute hospital admission, need for continued stay, and proper level of care billing based on clinical outcomes.
• Responsible for processing concurrent and retrospective denials in collaboration with clinical utilization management staff and internal physician advisors.
• Under the direction of management, develops, coordinates and monitors systems for the appeal/denial process, tracks and trends data, and coordinates utilization management operations activities with leadership and key stakeholders.
• Collaborates with other departments.
• Monitors and acts as a liaison between leadership, external payers, staff, and other related services and departments to assist with troubleshooting, tracking, and trending the appropriate level of service, payer behavior, and identifying opportunities for improvement.
• Assists with assigned projects and participates in department meetings and team discussions.
• Adheres to all local, state, and federal regulations, codes of conduct, policies, and procedures to ensure privacy and safety while delivering optimal patient care.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED