Coordinator, Utilization Management

📋 Description

• • CorroHealth is seeking a dedicated and detail-oriented Coordinator, Utilization Management to join our remote team. Our mission is to empower clients to achieve their financial health objectives through scalable solutions and clinical expertise across the entire reimbursement cycle. We leverage leading technology and data-driven analytics to guide our strategies and ensure accountability in reaching our goals. At CorroHealth, we are committed to fostering long-term careers by investing in our employees' professional development and personal growth, believing that individual success directly contributes to our collective achievements.
• • In this pivotal role, you will be responsible for the comprehensive management of the authorization process from initiation to completion. This includes receiving initial notifications, accurately entering and submitting all required patient and clinical information, diligently following up with healthcare payers, and tracking the process through to the final determination and patient discharge.
• • A critical aspect of your role will involve meticulous record-keeping. You will maintain detailed and up-to-date documentation within the Electronic Medical Record (EMR) system, CorroHealth's internal systems, and various Health Payer portals, ensuring all information is accurate, complete, and readily accessible.
• • You will play a key role in verifying patient eligibility and benefits, ensuring that services are covered and that all necessary pre-authorizations are in place before care is rendered. This proactive approach helps prevent claim denials and ensures a smoother patient experience.
• • Acting as a vital liaison, you will facilitate seamless communication between hospital staff and Health Payers. Your efforts will ensure timely and accurate information exchange, which is crucial for the successful and efficient completion of the utilization management process within established timeframes.
• • A thorough understanding of timely filing guidelines related to the utilization management process is essential. You will ensure all submissions and follow-ups adhere to these critical deadlines to maintain compliance and optimize reimbursement.
• • You will actively track and follow up with payers on pending authorizations, employing persistent and effective communication strategies to secure timely responses and approvals. This proactive follow-up is key to minimizing delays in patient care and revenue cycles.
• • Your responsibilities will extend to directly contacting payers to gather further information regarding the status of authorizations, understand decisions, and proactively identify and remove any obstacles that may hinder the processing of requests.
• • You will be adept at identifying and escalating potential issues that could lead to delays in authorization or outright denials. Early identification and prompt escalation allow for timely intervention and resolution, protecting both the patient's access to care and the organization's financial interests.
• • You will effectively manage your assigned workload of accounts, employing strong organizational skills and consistent follow-up to ensure all tasks are completed accurately and on time. This includes prioritizing tasks and managing multiple requests simultaneously in a fast-paced environment.
• • Maintaining strict compliance with HIPAA regulations and all other relevant healthcare laws and guidelines is paramount. You will ensure all actions and documentation meet the highest standards of privacy and security.
• • This role requires a proactive approach to problem-solving, excellent communication skills, and the ability to work independently while collaborating effectively with internal teams and external stakeholders. Your contribution will directly impact patient access to care and the financial health of the organization.