How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.
Work Shift
Day (United States of America)
The Utilization Review Assistant supports the UM Nursing department systemwide with non-clinical duties, tasks, and functions within the department to ensure these duties are performed timely. This employee is responsible for selected functions related to general clerical work and support duties that may include work flow maintenance, private and governmental payer authorization related processes, maintaining electric filing system, performing data entry, preparing correspondence, processing documents, managing schedules, answering multi-line phone systems, scanning, faxing, coping, and non-clinical EPIC documentation related to obtaining authorizations. The Utilization Review Assistant will assist UM Nursing team to close EPIC cases that require non-clinical interventions. Training is available.
ASSESSMENT / CLERICAL SUPPORT
* Answer multi-line incoming phone calls, forward calls as appropriate, and review voicemail boxes hourly.
* Produce, distribute, receive, review, and process all faxes and process per protocol.
* Develop and maintain electronic files for incoming communications and disseminate as appropriate.
* Research and create presentations as needed,
* Communicates with appropriate UM Nursing team members related to departmental related duties.
* Prepare and monitor invoices as needed.
* Handle all confidential information in a professional manner.
* Take minutes for departmental staff meetings.
* Monitors for compliance of Medicare/Medicaid regulations, including delivery of MOONs and associated mailing.
EPIC WORKFLOW/DISPOSITION PLANNING
* Supports the UM Nursing team with assigned functions in EPIC work que space related to obtaining timely authorization information and coordinates with UM Nursing team.
* Escalating denial information received immediately to UM Nursing team.
* Develop and maintain contact list
* Understands eligibility processes and criteria for both private and government payers. Places call to payers to update and document authorization information in a timely manner.
* Search payer web portals to update and document authorization information in a timely manner.
* Generate EPIC and other reports as needed.
Documentation
* Document all attempts made to obtain authorizations by phone, fax, or web portal.
* Document receipt of all incoming calls, faxes, or other communicated information related to Centralized UM department activities.
* Document escalation of all denial related communications to UM Nursing team in a timely manner.
* Communicates steps taken and determinations provided by insurance payers/web portals in a timely manner
* Document the authorizations obtained in the Electronic Health Record
* Document efforts made to regarding reconsideration efforts with all denials when received
* Must provide sufficient and appropriate documentation required by GAMMIS for Medicaid pre-cert approvals on the GAMMIS portal
Professional Development and Initiative
* Completes all initial and ongoing professional competency assessment, required mandatory education, population specific education.
* Develop administrative support staff by providing information, educational opportunities and experimental growth opportunities.
Performs other duties as assigned
Complies with all WellStar Health System policies, standards of work, and code of conduct.
High School Graduate
All certifications are required upon hire unless otherwise stated.
Minimum 3 years experience working with customers/clients and strong clerical background Required and
Strong computer skills and Microsoft office products Required and
Hospital and/or Medical front and/or back office background Preferred
Excellent time management skills and proven ability to multi-task and prioritize work.
Attention to detail and problem-solving skills a must.
Excellent written and verbal communication skills a must.
Strong computer skills including: Microsoft office suites with emphasis on Word, Excel, Power Point, Outlook.
Ability to interact appropriately with stakeholders from various departments.
Ability to work autonomously a must.
Strong ability to build and sustain trust with the entire team.
Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.
At Wellstar Health System, our mission is to enhance the health and well-being of every person we serve. Nationally ranked and locally recognized for our high-quality care, inclusive culture and world-class doctors and caregivers, Wellstar is one of the largest, most integrated healthcare systems in Georgia.
Our specialists and primary care providers work in a multidisciplinary environment with nearly 30,000 diverse team members throughout our hospitals, health parks and medical offices. Communities can also access our outpatient centers, a pediatric center, nursing centers, and hospice and home care services. We’re proud to be home to the second-largest Emergency Department in the country, as well as being the only system in Georgia operating multiple trauma centers.
We’re also known for our exceptional work culture, featured on the Great Places to Work®, Fortune 100 Best Companies to Work For® and the Seramount Best Company for Multicultural Women® lists. We continue to attract the best and the brightest in healthcare.
At a time when our industry is changing rapidly, Wellstar remains committed to exceeding expectations from our patients and team members, while transforming healthcare delivery. We stand behind our values to serve with compassion, pursue excellence and honor every voice.
