Brief Summary of the position

To assist Inpatient Utilization Management RN’s and Unit Assistant by completing data entry and collaborating with insurance companies.

Responsibilities and Expectations

Running discharge report and notifying insurance company of the discharge. Emailing denial letters to physicians, maintain denial spreadsheet, follow up on P2P’s and document outcomes and notifications in denial tab. Ability to multitask phone calls, emails, and faxes. Call insurance company for approvals Scheduling and obtaining prior auth for OP testing, labs, infusion ect. Obtaining prior authorization for post-acute services Ability to interact with patients, employees, and other occupants in an appropriate manner. Moon forms/CC44 compliance. Provide moon forms for surgeries, direct admits, status changes and transfers. Provide a copy to the patient, original copy placed in chart and document completion of the moon form/CC44 in Cerner. Occasional mailing of moon form via certified mail. Utilizing payer websites for approvals, prior authorization, and denials. Keep up to date on payer policies. Covering Unit Assistant PTO Assist Unit Assistant with faxes, approvals, and Kronos as needed. Ability to receive, understand, and implement direction from supervision and management. Ability to effectively function within the framework of department and organizational policies and procedures. Other duties as assigned by the Director or designee.

Education/Experience Requirements

High School Diploma or equivalent

Job Location

Aultman Hospital Main Campus