The Outpatient Utilization Review Assistant, using decision trees and standard work, is responsible for a broad range of utilization review support services to ensure efficient authorization coordination including registering patients, eligibility verification, scheduling patient visits, obtaining authorizations, preparing billing data through data entry in EMR and 3rd party billing systems, maintaining patient information through chart documentation in EMR, preparing required reports and providing other support as requested. The Outpatient URA is responsible for selecting appropriate chart documents to submit timely requests to government insurances, private health plans, medical groups and IPAs to secure authorizations and documents activities and authorizations per standard work. The Outpatient URA is able to navigate and understand payer portals for transmission of authorizations.
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.
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