Team Lead Utilization Review Authorization Coord - REMOTE

POSITION SUMMARY:

The Utilization Review Authorization Coordinator Lead will work with Utilization Review Authorization Coordinators and other facility staff to coordinate the appropriate information and actions necessary to ensure proper authorizations are obtained for care of patients. Identify and review denial patterns while working with UR Managers, UR Educators, and Care Management Team to positively impact outcomes.

KEY RESPONSIBILITIES:

• Oversight of the Utilization Review Authorization Coordinators in assigned area.
• Responsible for daily assignments to ensure proper coverage for all facilities.
• Monitoring productivity and conducting team member audits.
• Assessing authorization holds and identifying hold reasons.
• Identifying areas of improvement in daily processes.
• Coordinating opportunities for education and workflow optimization.
• Communicating with payors to ensure an efficient working relationship.
• Oversees pre-denial process for facilities assigned to regional area.
• Follows up on pre-denial metrics monthly to ensure accounts are documented appropriately.
• Reports pre-denial findings and trends to utilization review managers and other identified facility team members.
• Attention to detail regarding documentation and follow-up to ensure process is completed in a timely manner.
• Effectively interact with all levels of the organization and maintain cooperative relations with internal and external customers.
• Document authorization numbers, concurrent denial, attempts to overturn concurrent denials and coordinate Peer-to-Peer communication as needed for all patient hospital stays.
• Follow-up communication with payors to ensure authorization obtained for patient hospitalization.
• Communicate appropriately with Utilization Review and Case Management team members to ensure patient and payor needs are met.
• Additional duties as assigned.

REQUIRED KNOWLEDGE & SKILLS:

• Good organizational skills.
• Ability to analyze data to determine underling trends.
• Ability to assist in development and process improvement in obtaining payor authorization and concurrent denials.
• Manages time effectively, sets priorities, and consistently meets deadlines.
• Excellent verbal and written communication skills.
• Ability to effectively interact with insurance companies.
• Demonstrates initiative and pro-active approach to problem resolution.
• Performs well independently and on a team.
• Assumes accountability for demonstrating behaviors consistent with the customer service policy.
• Works competently with computer based charting and other clinical and non-clinical software programs.
• Readily adapts to change.
• Operates office equipment efficiently.
• Ability to create analytic documentation and presentations.
• Critical thinking skills required.
• Medical Terminology.

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

1. Education: Minimum High School graduate or GED equivalent.[ML1]
2. Experience (Type & Length): Minimum 3 years’ experience as an authorization coordinator or similar experience. Minimum 1 year experience in a supervisory role.
3. Software/Hardware: Proficient computer skills required, i.e. Word, Excel, Microsoft Office
4. Other: Understanding of the health care delivery setting. Ability to read and communicate effectively in English required, ability to communicate in additional languages preferred.