Phelps Health Job - 32612144 | CareerArc
  Search for More Jobs
Get alerts for jobs like this Get jobs like this tweeted to you
Company: Phelps Health
Location: Rolla, MO
Career Level: Entry Level
Industries: Healthcare, Pharmaceutical, Biotech


General Summary

  • The Clinical Reviewer assists with data collection, entry and generation of reports; coordinates communication between Patient Financial Services, Third party Payers, patients, and physicians; and performs certifications, authorizations, concurrent reviews, and appeals. The clinical reviewer will be responsible for reviewing inpatient and observation patients and performing certifications/authorizations for Medicare, Medicaid, Commercial, and Medicare HMO third party payers.
Essential Duties and Responsibilities
  • Performs pre-certification, concurrent, retrospective and appeal review in an accurate and timely manner to assure reimbursement for Phelps Health.
  • Acts as liaison between Patient Financial Service members and Care Management team.
  • Works cooperatively with physician offices, communicating necessary information to assure reimbursements.
  • Assists the Care Managers in visiting patients to check on discharge needs.
  • Assists the Care Managers in referral calls for pre & post hospital care.
  • Assists with communicating discharge-planning information to Third Party Payors and care providers.
  • Completes appeals, back certifications, and retrospective reviews for the Denial, Prevention and Recovery department.
  • Works under pressure and pays close attention to detail.
  • Communicates clearly and effectively with a wide variety of individuals.
  Job Qualifications
  • Education
    • Graduate of an approved practical nursing program or an equivalent combination of education and experience.

  • Work Experience
    • At least two (2) years clinical experience in Utilization Management, Social Services, and/or Quality Management required. Experience working with third party payers is preferred.

  • Certification/License
    • None required
Mental/Physical Requirements
  • Considerable mental concentration required. Lifting up to 35 lbs., turning activities and nearly constant walking required. Standing, turning, carrying, pushing, pulling, stooping, crouching, twisting, and reaching.
Working Conditions
  • Frequent exposure to infectious disease and hostile persons at times. Frequent exposure to communicable disease via blood and other body fluids. Minimal physical discomfort.

 Apply on company website