UM Coordinator Remote

AdventHealth Corporate

All the benefits and perks you need for you and your family:

• Benefits from Day One

• Career Development

• Whole Person Wellbeing Resources

• Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift : Full-time; Monday - Friday

Job Location : Remote

The role you'll contribute:

The Utilization Management (UM) Coordinator works under the direction of the Utilization Management Manager and supports the Utilization Management team with Emergency, Observation and Inpatient visits. The UM Coordinator is responsible for processing and documenting clinical requests, authorizations/approvals and denial communication from payors via fax (Vyne), email or phone. The UM Coordinator is responsible for collaborating with all members of the UM team or interdependent departments (i.e. Patient Access, Billing, etc.) to ensure unnecessary delays in patient care, discharge or billing. The UM Coordinator is responsible for timely escalation of barriers to the UM Specialist or Supervisor, as appropriate, and will assist in payor communication/coordination, as needed.

The value that you bring to the team:

• Supports clerical and administrative activities of the Utilization Management team

• Monitors and addresses electronic faxes and email from payors

• Forwards communication to appropriate Utilization Management team member

• Enters pertinent approval and denial information into the appropriate computer programs for Utilization Management team members to review and address in a timely manner

• Monitors the Centralized Phone Line for telephonic authorization and denial information from payors

• Manages and monitors mail from the department mailbox, which includes uploading letters from payors to patient encounters and forwarding correspondences to applicable Departments

• Serves as a liaison for payor reviewer, PFS (Patient Financial Services), and Pre-Access

• Works closely with the UM Specialist and Supervisor

• Tracks and trends payor issues and potential contractual issues and escalates to Utilization Management leadership

• Manages multiple clerical duties and assigned projects, while sustaining the department's key initiatives in support of daily operational flows and special projects as required

• Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level before releasing account information.

• Completes any other tasks within department guidelines

Qualifications

The expertise and experiences you'll need to succeed :

• High School diploma or GED

Preferred Qualifications :

• Associate degree and/or higher-level education, or completed coursework, in Health Services Administration or other related medical or business field

• Experience in health care, hospital setting, and/or Patient Finance Services

• Knowledge of Utilization Management processes

• Knowledge of Care Management processes/workflows