Utilization Review Coordinator

Responsible for ensuring that all initial authorizations are initiated with appropriate payor, required notes are documented, and the authorization detail is set up in Case Management. The information is subsequently verified in the payor websites where applicable. Review Daily Discharges to ensure that all days are authorized and identify denied days, coordinate with Director of Utilization Review and add to Denial Tracker when appropriate. Monitor and update file for accounts without discharge diagnosis.

KEY RESPONSIBILITIES:

Initial Authorizations

Runs the morning report and identifies all accounts where an authorization doesn’t exist and enters appropriate data in the appropriate field to identify the department responsible for obtaining initial authorization. Confirms the level of care matches in AIS with the patient diagnosis and the insurance authorizations.  

Daily Discharges

At the direction of the UR Director, retrieves required documentation from the patient’s medical record per EMR for daily discharges and processes according to payor requirements. When appropriate, forwards discharge documents to UR staff for processing.

UR Ring Central Fax

On a daily basis, monitors UR Ring Central fax and labels with UR staff assigned to the case when completed.

Appeals

As directed by UR Director, retrieves patient records from EMR, prints chart, and forwards chart to staff responsible for appeal.  When appeal letter is complete, copy entire appeal packet, prepare postage, pack and mail original. Scans and indexes designated appeal documents in doc link. Reviews with UR Director per denial tracker updates.  Maintains file of copied appeals for resolution.   

Discharge Authorizations

As needed, verifies that all authorizations are updated in AIS by verifying either in the payor website or calling insurance company.  Responsibility is to ensure that days are not left in GAP or pending status before the claim is generated.

Accounts pending Discharge Diagnosis

On a daily basis, updates the number of discharges per day and accounts pending discharge diagnosis.

Requirements

• High school degree or equivalent required
• Two (2) years’ healthcare experience preferred
• Previous experience with the Nevada Psychiatric/Substance Abuse Insurance Market required
• Knowledge of CPT/ICD-10 coding helpful
• Experience using Microsoft word and excel

Benefits

Eligible for benefits 1st of the month following 30-days of employment.

Desert Parkway offers competitive benefits to include:

• Health insurance
• Vision insurance
• Dental insurance
• 401K Retirement Plan
• Healthcare spending account
• Dependent care spending account
• PTO Plan with holiday premium pay
• Discounted cafeteria meal plan
• Life insurance (Supplemental Life, Term and Universal plans are also available)
• Short- and long-term disability (with additional buy-in opportunities)