The Utilization Review Assistant, using decision trees and standard work, determines appropriate chart documents and timely transmits the documents to government and private health plans to secure authorizations. The URA documents activities and authorizations per standard work.
Essential Job Outcomes & Functions:
- Appropriate chart documents are chosen and transmitted per decision trees and standard work.
- Chart documentation is transmitted per department timeliness requirements.
- Documentation in the billing system of activities and authorizations is complete and timely.
- Duties performed meet department productivity requirements.
- Accepts full responsibility for personal behavior and contributes as a team member to complete tasks, resolve problems, and achieve goals. Follows through on commitments. Take responsibility for their actions.
- Complies with regulatory requirements, applicable laws, and policies and procedures set forth by the organization and individual departments. Maintains all license and certification requirements.
- Effectively manages time and resources to reduce waste and complete individual, team, unit/department, or organizational-wide work activities.
- Proactively seeks improvement opportunities to increase effectiveness and efficiency. Supports and embraces necessary change, demonstrates openness to new ideas, processes and technologies. Works collaboratively to implement new strategies and improve team performance. Consistently implements practices to improve patient safety, customer service and quality care.
- Pursues both internal and external learning opportunities for self and professional development. Proactively takes responsibility for learning about trends and changes in their given field. Regularly seeks and accepts feedback for development and improvement. Recognizes additional work or duties as an opportunity to grow professionally.Focused on providing the highest level and quality of customer service. Exhibits professionalism, respect and dignity at all times. Demonstrates a personal commitment to understanding, meeting and exceeding the needs of fellow employees, patients, physicians, and guests. Delivers proactive, helpful, courteous and knowledgeable service.
- Practices open and honest communication demonstrating support and empathy. Respectfully asks questions and practices active listening to gain full understanding of diverse perspectives. Maintains the self-esteem and confidence of others. Effectively conveys both written and oral communication to achieve mutual understanding, while appropriately adapting the message, style and tone to accommodate a variety of audiences
- Participates as active team member, demonstrating a willingness to engage and accept shared responsibility. Works cooperatively and collaboratively within and across departments to achieve positive results.
- Allocates time and resources efficiently and effectively; prioritizes work and delegates as appropriate; works to minimize institutional risk by acting as a responsible steward for the organization.
- Is organized and has the ability to manage multiple tasks at one time. Organizes work, sets priorities, and determines resource requirements; determines the necessary sequence of activities needed to achieve goals.
2+ years medical office/UR Department/Admitting Central Auth Unit/medical group experience in utilization review, insurance contracts, multi-payer inpatient authorization systems and/or business office operations is required.