Sanantoniobehavioral
PRN UR Coordinator
San Antonio, Texas, United States
Sponsorship not specifiedDetected 422 days ago
ExpressComplianceCustomer SupportHIPAACommunicationMicrosoft Office
About the role
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition.
- Monitors patient charts and records to evaluate care concurrent with patients' treatment.
- Reviews treatment plans and status of approvals from insurers.
Requirements
- Ability to express and exchange ideas via spoken word during activities in which they must convey detail or important spoken instructions to others accurately, sometimes quickly and loudly.
- ability to perceive detailed information orally and make fine discriminations in sound.
- Individual must be able to exert up to 100 pounds of force occasionally and to be able to lift, carry, push, pull, or otherwise move objects.
- Must be able to work and concentrate amidst distractions such as noise, conversation and foot traffic
Nice to have
- Identify and facilitate resolution of system process problems impeding UM functions.
- Identify and resolve delays and obstacles as appropriate.
- Reviews notices of potential denials and respond appropriately
- i.e. facilitate Physician to Physician appeals when appropriate and assist with construction of appeal letters.
- Tracks denial information for reporting to Quarterly UR Committee.
- Enters complete and accurate documentation into the system describing all patient related admitting/registration activities.
- Follows all regulatory policies and procedures, privacy and security standards in accordance with government agencies including HIPPA requirements.
- Performs other duties as required.
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