UR COORDINATOR

POSITION PURPOSE:

The Utilization Review Coordinator (UR Coordinator) is responsible to perform the process of utilization review to ensure appropriate reimbursement by third party payers. This includes managing concurrent reviews for multiple locations and levels of care, the denial/appeals process, as well as the flow, organization, and reporting of information.

POSITION REQUIREMENTS/QUALIFICATIONS

EDUCATION:

Master's degree from an accredited college or university in social work, mental health, nursing, or related degree required.

EXPERIENCE:

Two years of UR experience in a hospital or healthcare insurance setting required.

LICENSURE/CERTIFICATION:

LMSW, LMHC, LPC, or other healthcare related licensure preferred

SPECIFIC AREAS OF RESPONSIBILITY TO POSITION

1. Obtain preauthorization for admissions and continued stays according to third party guidelines within one business day of admission (unless otherwise required), including researching and obtaining any necessary insurance contact information, and coordinating scheduled meetings between hospital and insurance doctors.
2. Manage and perform the processes for retrospective authorizations and denials/appeals.
3. Timely communicating preauthorization outcomes, follow-up instructions, options, and related information to relevant administrative and clinical staff. This includes responding to all calls and emails within one business day unless otherwise required.
4. Document activity in Billing and UR software and preparing reports for meetings and management review.
5. Organize and filing documents for ease of access in approved locations.
6. Assist in compiling information for data analysis relating to preauthorization and reimbursement.
7. Provide assistance to facility staff in determining the likelihood of insurances covering treatment.
8. Maintain patient confidentiality in accordance with state and federal law.
9. Participate in internal information meetings, required in-service education and training, and company-wide performance improvement and compliance activities.
10. Protect the privacy of all client information in accordance with GRNH, LLC’s privacy policies, procedures, and practices, as required by federal and state law, and in accordance with general principle of professionalism as a healthcare provider. Failure to comply with the company’s policies and procedures on client privacy may result in disciplinary action up to and including termination of employment.
11. May access protected health information (PHI) and other patent information only to the extent that it is necessary to complete your job duties. The incumbent may only share such information with those who have specific client information you have in your possession to complete their job responsibilities related to treatment, payment or other GRNH, LLC operations.
12. Expected to report, without the threat of retaliation, any concerns regarding GRNH, LLC’s policies and procedures on client privacy and any observed practices in violation of the policy to their supervisor.
13. Perform other duties as assigned