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Bryan Health · 8 hours ago

Utilization Management Assistant

Lincoln, NE

Full-time

Onsite

Entry Level

2+ years exp

Bryan Health is seeking a Utilization Management Assistant to support their Utilization Management team by obtaining necessary documentation for insurance purposes and explaining these documents to patients. The role involves monitoring utilization activities and ensuring compliance with insurance requests, while collaborating with various departments to optimize patient care and reimbursement.

Health CareHospitalNon Profit

Responsibilities

Commits to the mission, vision, beliefs and consistently demonstrates our core values

Understands and operationalizes federal regulations regarding Advance Directives, COBRA, Medicare, Corporate Compliance, Joint Commission, OSHA and HIPAA; reports safety and customer concerns

Administers and documents appropriate Medicare Outpatient Observation Notice (MOON), Hospital Issued Notices of Non-Coverage (HINN), Advanced Beneficiary Notices (ABN) and other documents as deemed appropriate

Adheres to current rules, regulations and policies related to the Medicare program, Medicaid program and third party payer guidelines

Interacts in an interdisciplinary manner and serves as a resource regarding patient’s insurance guidelines and requirements

Routes insurance inquiries to the proper persons and departments

Assists with Utilization Management functions by participating in concurrent and retrospective denials and appeals processes by researching issues surrounding the denial

Assists with admission notification for third party payers

Assists with the process of pre-screens for clinically appropriate admissions and determination for coverage for post-acute services or other transfers

Participates in prioritization and data collection and documentation for time-limited clinical quality or research indictors as requested. Attends staff meetings, mandatory in-services and hospital committee meetings as required

Supports and is involved in the Medical Center’s quality initiatives

Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise

Participates in meetings, committees and department projects as assigned

Performs other related projects and duties as assigned

Qualification

Medical terminologyPharmacological terminologyBasic Life Support certificationComputer software applicationsJudgmentProfessionalismIndependenceEffective communicationConfidentialityDocumentation accuracyInterpersonal skills

Required

Knowledge of medical and pharmacological terminology

Knowledge of computer hardware equipment and software applications relevant to work functions

Skill in responding to patient, family and visitor needs with courtesy, consideration, tact and sensitivity

Ability to work independently with minimal supervision

Ability to modify work assignments based on customer requirements

Ability to meet deadlines in a sometimes rapidly changing environment

Ability to communicate effectively both orally and in writing

Ability to maintain strict confidentiality relative to sensitive information

Ability to maintain accurate documentation

Ability to exercise sound judgment, courtesy, tact and professionalism in interacting with others

Ability to communicate and cooperate with all levels of personnel, medical staff and auxiliary and ancillary departments fostering and promoting intro and inter departmental relationships

Ability to work in a fast-paced environment related to changing patient needs including working with patients with acute, chronic and complex disease processes

Ability to maintain regular and punctual attendance

Basic Life Support (CPR) certification required