Posted in Other 12 days ago.
Utilization Management Representative
Location: Pearland Admin Office
Job Type: Full Time
Department: Utilization Management
Kelsey-Seybold Clinic. Changing the way health cares.
Kelsey-Seybold Clinic is Houston's premier multispecialty group practice, founded in 1949 by Dr. Mavis Kelsey. With 19 clinic locations and more than 400 physicians, Kelsey-Seybold provides medical care in 55 medical specialties and is home to a nationally accredited Breast Diagnostic Center, Endoscopy Center, Infusion Center and Cancer Center. Our mission is to provide our team members with exceptional opportunities for professional and personal growth.
The Utilization Management Representative (UMR) provides office support for all units within the Utilization Management and/or Population Health Department. (Utilization Review, Concurrent Review, Population Health and Case Management.) The UMR position will assist with incoming authorization requests; data entry of clinical information, pre-certification requests. Additional responsibilities include direct communication with KSC Clinic Representatives as needed. The Utilization Management Representative is responsible for clerical support relative to the Bed Day process. Under the supervision of the Transfer Nurses, the Utilization Management Representative is primarily responsible for the collection, reporting, clarification and entry of bed day data and pre and post-acute certification requests for specific services. Under the supervision of the Health Service Supervisor, the Utilization Management Representative is primarily responsible for collection of non-clinical data, report generation, health plan coordination for non-clinical issues, and other administrative duties that are required to provide comprehensive coordination of services. Additional duties can include handling and appropriately directing referral status requests received via phone and assisting with requesting clinical updates via phone and fax from facilities. Other duties as assigned.
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
(A = basics; B = preferred)
High school diploma or GED from an accredited program.
College level courses
2 -3 years of managed care experience either in a physician office or hospital setting health plan, ACO, or other managed care setting.
Knowledge of CPT & ICD 10 Coding methodologies.
Valid Tx driver's license
Epic System usage.
Knowledge of medical terminology, HMO, PPO and referral processes.
Excellent communication skills
Alpha/numeric data entry and basic PC Literacy
Excellent time management skills