Utilization Management Analyst

Job Description:

This position provides monitoring of inpatient and outpatient accounts to ensure accuracy of submissions and proper authorizations are obtained in order to secure reimbursement. The success is measured by the ability to reduce bill holds. This includes working closely with the clinical team, including the utilization review nurses and the physician advisors.

In addition support and follow up is performed with the Insurance verification team. The role includes but is not limited to, clinical submission to the payers, securing an authorization for the visit type, continuous follow up with payers for authorizations and/or additional information, and basic reporting for payer specific behaviors. This also requires monitoring of payer trends and the user of Microsoft office to track and report out data for Senior Management