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Providence Health & Services Utilization Review Specialist in Kodiak, Alaska

Description:

Providence is calling a Utilization Review Specialist (Dept, Shift, 0.0 FTE) to Providence Kodiak Island Medical Center in Kodiak, Alaska. We are a community of caregivers delivering every day on our Mission to provide compassionate care that is accessible for all - especially those who are poor and vulnerable.

In this position, you will:

  • Ensure verification of insurance eligibility.

  • Identify services and payers requiring authorization and ensure required authorizations are in place.

  • Identify services requiring referrals/consent forms and ensure they are signed and in place.

  • Validate motor vehicle accident, workman’s compensation or other third party liability paperwork has been completed.

  • Process real time eligibility and assigned denial work queues timely and accurately.

  • Assist with external review companies, agencies, and consultants, using advocacy and negotiating skills that address medical necessity and appropriateness of inpatient/outpatient levels of care.

  • Assist department with tracking and managing length of stay, avoidable days, denials and appeals of inpatients/outpatients.

  • Assist in obtaining required authorizations for inpatient admissions.

  • Use multiple computer applications to establish accounts and obtain verification information.

  • Maintain accurate, clear, concise, and complete account notes and other relevant information.

  • Assist in decreasing liability risk factors for the institution by applying quality screens to medical records and analyzing data for potential risks.

  • Assist the department in the appeals process upon receipt of a non-qualifying determination.

  • Consult, collaborate with, and value team members and other health professionals to plan and assure transfer of timely information, in order to meet patient and family needs in a seamless, safe, and effective process.

Qualifications:

Required qualifications for this position include:

  • High School diploma or equivalent

  • Basic Life Support (BLS) certification within 90 days of hire

  • Knowledge of medical terminology

  • 1 year experience with hospital and/or clinic billing experience

  • Ability to work well with ill, disabled, elderly, and emotionally distressed patients/families

Preferred qualifications for this position include:

  • Associate’s degree in a clinical healthcare or business field

  • 1 year of utilization review experience

  • Knowledge of CPT and ICD10 coding

  • Knowledge of State, Federal and other regulatory compliance regulations, including Medicare, EMTALA and ABN

About Kodiak Island Medical Center

Providence Kodiak Island Medical Center (PKIMC) provides comprehensive health care to residents and visitors of Kodiak Island. This critical access hospital features 25 acute care beds, including four birthing suites, one OB triage room, and two ICU beds. In addition, the Elder House, PKIMC’s long term care facility, has 22 beds.

PKIMC provides an extensive array of inpatient and outpatient services, including emergency department, surgery, laboratory services, maternity, general medicine, physical therapy, occupational therapy, respiratory therapy, sleep studies, specialty clinics, diagnostic imaging services and pharmacy and is staffed by a mix of primary care physicians, surgeons and specialists who provide family practice, internal medicine, obstetrics, radiology and general practice.

For more information regarding Providence Kodiak Island Medical Center, please click on the following link: http://providence-kodiakhealthcare.jobs/

We offer a full comprehensive range of benefits - see our website for details

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: On Call

Shift: Day

Job Category: Administrative (Clinical)

Location: Alaska-Kodiak

Req ID: 241087

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