National Association of Latino Healthcare Executives · 11 hours ago
Utilization Analyst
Downey, CA
Full-time
Onsite
Mid LevelThe National Association of Latino Healthcare Executives is focused on improving healthcare services for Latino communities. They are seeking a Utilization Analyst to coordinate and supervise data management, analyses, and reporting for utilization management and Continuing Care Services.
Health CareHospitalMedical
Responsibilities
Coordinates and supervises data and reporting needs, data collection process and data processing issues and provides timely utilization data and analytic support
Frequent contacts with other organizational units and outside facilities staff to obtain, verify and/or provide information, e.g., works with Regional Claims and outside hospitals to reconcile billing charges
Answers inquiries and educate patients, physicians and hospitals on covered benefits and charges
Provides information and assistance to Health Plan members during claims review process and coordinates authorized and non-authorized claims review
Documents outside medical services and reinforce procedures for patients seen in outside emergency department
May coordinate and supervise Air & Ground Transportation and Prospective Review Authorization Program
Coordinates and supervises claims and referral information
Provides information regarding member admissions to outside facilities
Maintain the consistency and integrity of the non-KFH utilization bed track computerized data management system
May assist in scheduling patient appointments and coordinating patient care
Qualification
Required
Coordinates and supervises data management, analyses and reporting for KFH utilization management and Continuing Care Services
Coordinates and supervises data and reporting needs, data collection process and data processing issues
Provides timely utilization data and analytic support
Frequent contacts with other organizational units and outside facilities staff to obtain, verify and/or provide information
Works with Regional Claims and outside hospitals to reconcile billing charges
Answers inquiries and educate patients, physicians and hospitals on covered benefits and charges
Provides information and assistance to Health Plan members during claims review process
Coordinates authorized and non-authorized claims review
Documents outside medical services and reinforce procedures for patients seen in outside emergency department
May coordinate and supervise Air & Ground Transportation and Prospective Review Authorization Program
Coordinates and supervises claims and referral information
Provides information regarding member admissions to outside facilities
Maintain the consistency and integrity of the non-KFH utilization bed track computerized data management system
May assist in scheduling patient appointments and coordinating patient care
Company
National Association of Latino Healthcare Executives
The National Association of Latino Healthcare Executives is a hospital and healthcare organization.
Founded in 2005
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Jackie Sifuentes, MBA, LSSYB
Co-Founder La Mesa Emerging Leaders Mentorship Program for Early Careerists
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