Overview
CHI Memorial Hospital now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI) and Dignity Health is once again the only hospital in the Chattanooga area to be named a Best Regional Hospital by U.S. News & World Report. We are proud to be the regional referral center of choice providing health care throughout Southeast Tennessee and North Georgia. We offer the following benefits to support you and your family: On-site childcare with extended hours Care@Work premium account for additional support with children pets dependent adults and household needs Employee Assistance Program (EAP) for you and your family Paid Time Off (PTO) Health/Dental/Vision Insurance Flexible spending accounts Voluntary Protection: Group Accident Critical Illness and Identify Theft Adoption Assistance Tuition Assistance for career growth and development Matching 401(k) and 457(b) Retirement Programs Wellness Program Additional incentives for eligible full time day shift and night shift opportunities
Responsibilities
Work from home requires regular onsite attendance (Chattanooga, TN)
Some weekends and holidays required
The CommonSpirit Utilization Management Assistant receives, processes, facilitates and documents all payer communications. This position supports denial mitigation by sending documentation within the contracted time period, following up on accounts lacking authorization and communicating with internal stakeholders to ensure the accurate submission of clinical documentation to third party payers. The Utilization Management Assistant supports the Utilization Management Hub department by recognizing trends and opportunities for process improvement and reporting those to leadership. The Utilization Management Assistant performs these duties with a high degree of accuracy utilizing critical thinking skills and in compliance with hospital policies, standards of practice and Federal and State Regulations.
Employees are accountable for demonstrating a strong commitment to promoting quality every day by demonstrating our organizational values of: Compassion, Inclusion, Integrity, Excellence, and Collaboration.
Essential Key Job Responsibilities
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Receives, sends and documents payer requests for clinical documentation.
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Receives and documents payer authorization and communications including but not limited to concurrent denials.
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Coordination of peer to peer conversations, as applicable.
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Reviews surgery schedule to verify correct authorization is documented, if applicable.
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Identifies accounts lacking authorization and follows up with payers, as needed.
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Communicates with interdepartmental staff regarding payer documentation requests.
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Under RN direction submits requests for and follows up on administrative days authorization, where indicated.
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Identifies and reports trends to department Leadership.
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Utilizes payer related reports from Care Management software, where applicable.
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Collaborates with and supports the UM team including but not limited to UR and Denials RN.
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Contributes to the identification of opportunities for process improvement.
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Supports administrative departmental functions, as assigned.
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Other job duties as assigned.
The job summary and responsibilities listed above are designed to indicate the general nature of the work performed within this job. They are not designed to contain or be interpreted as a comprehensive inventory of all job responsibilities required of employees assigned to this job. Employees may be required to perform other duties as assigned.
Qualifications
Required
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Minimum one year experience in a hospital, physician’s office, or medical group performing duties related to admitting, business office, payer communications or managed care or an equivalent combination of education and experience
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High school diploma or GED required
Required
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Demonstrated ability to apply problem solving skills
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Excellent customer service and presentation skills are a must
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Strong interpersonal and written communication skills are essential
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Demonstrated ability to manage multiple tasks or projects effectively
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Ability to work independently as needed with a high degree of detail orientation.
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Ability to work efficiently in a fast-paced environment with changing priorities
Preferred
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An understanding of operations and functions of care coordination, utilization management, denials mitigation is preferred.
Pay Range
$18.74 - $25.77 /hour