Sanford Health ยท 1 day ago
Utilization Management Coordinator (Home-Based) - Prior Authorization
Minnehaha County, SD
Full-time
Remote
Senior Level
$19/hr - $28/hr
7+ years exp
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Responsibilities
Monitors the utilization of resources, risk management and quality of care for patients in accordance to established guidelines and criteria for designated setting and status.
Collection of clinical information necessary to initiate commercial payor authorization.
Obtain and maintain appropriate documentation concerning services in accordance to reimbursement agency guidelines.
Consult with interdepartmental departments and staff to assure all relevant information regarding patient status and diagnosis are accurately reported.
Provide information via multiple sources of technology applications to insurance companies and contracted vendors to assure authorization for patients.
May participate in providing assistance in financial aid and/or counseling if applicable.
Accurately recognizes coding principle diagnosis and principle procedures including complicating/comorbid diagnoses for accurate diagnosis-related group (DRG) assignment during hospitalization.
Monitors patient hospitalization to ensure prospective payment limit is not exceeded without due notice to the attending physician.
May also need to notify physician and patient of authorization denials.
Inputs collected data into computer system for insurance communication, DRG grouping, data abstraction for monitoring and evaluation, and when applicable, Medicare National and Local Coverage Determinations (NCD/LCD), and Joint Commission (TJC) required functions and credentialing.
Assists medical records coding personnel as needed to correctly identify diagnoses and procedures, and obtains physician documentation as needed.
Monitors patient hospitalization to ascertain medical necessity and appropriateness.
Assists with retrospective review of specified charts as required.
Ability to interact on an interpersonal basis with both providers and nursing staff.
Demonstrates proficiency with computers, Microsoft applications, and additional designated technology within the department.
Will perform multiple administrative duties including accurate record keeping and electronic data management when needed.
Ability to work with growth and development needs of pediatric to geriatric populations.
Qualification
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Required
Appropriate education level required in accordance with licensure.
Seven years of relevant experience, superior communication and interpersonal skills.
Minimum one year healthcare or clinical experience required.
Currently holds an unencumbered Licensed Practical Nurse (LPN) license with State Nursing board and/or possess multi-state licensure privileges, or Registered Health Information Technician (RHIT) required.
Obtains and subsequently maintains required department specific competencies and certifications.
Preferred
Specific background or experience in healthcare reimbursement, insurance industry, and/or authorization experience would be critical to the success in this role.
Pharmacy technician or coding certifications also acceptable, i.e. Certified Coding Specialist (CCS), Certified Coding Specialist - Physician based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder - Hospital (CPC-H), Certified Outpatient Coder (COC), or Certified Ambulance Coder (CAC).
Benefits
Health insurance
Dental insurance
Vision insurance
Life insurance
A 401(k) retirement plan
Work/life balance benefits
A generous time off package to maintain a healthy home-work balance
Company
Sanford Health
Sanford is a healthcare company providing research, education and clinical care.
10,001+ employees
H1B Sponsorship
Sanford Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (17)
2022 (54)
2021 (69)
2020 (34)
Funding
Current Stage
Late StageLeadership Team
Baier Roger
CEO
B
Bill Gassen
President & Chief Executive Officer
Recent News
Canada NewsWire
2024-11-19
2024-10-24
Sanford Health News
2024-04-26
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