Authorization Representative – Utilization Management – Maitland in Maitland, FL at Adventist Health System

Date Posted: 11/10/2018

Job Snapshot

  • Job Schedule
    Full-Time
  • Location:
    Maitland, FL
  • Job Category
  • Date Posted:
    11/10/2018
  • Job ID:
    269010
  • Job Function
    Facilities Services / Housekeeping / Security
  • Travel
    No
  • Shift
    Day
  • AHS Zone
    2-Legacy System
  • Organization
    Florida Hospital

Job Description



Utilization Management Authorization Representative – Utilization Management – Maitland

Florida Hospital seeks to hire Utilization Management Support Specialist who will embrace our mission to extend the healing ministry of Christ.



Facility Profile:

Established in 1908, Florida Hospital is one of the largest not-for-profit healthcare systems in the country, caring for more than a million patients each year. The Maitland Office Plaza houses our highly skilled teams that support our hospital system including Marketing, Patient Financial Services, Revenue Management, the Credit Union and Human Resources. The Trickel Building, a two-story office structure, creates an atmosphere of health and healing, with a healthy-style café and quaint chapel. The main lobby is filled with lush greenery and a light trickle of water, creating a holistic environment.



Work Hours/Shifts:

Monday – Friday; 8a – 4:30p



Job Summary:

The Utilization Management Authorization Representative, under general supervision from the Utilization Management Manager, maintains performance standards by verifying authorizations that are in place for all inpatient and observation patient accounts, meets timeline standards established by leadership and meets contractual obligations for all patient services. Meets or exceeds department audit accuracy standard goal. Obtains authorizations and verifies that inpatient notifications are accurate according to the registration or admission level. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. Adheres to Florida Hospital Corporate Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.



Knowledge, Skills, Education, & Experience Required:

  • Ability to maintain confidentiality; meets HIPPA requirements when discussing or disseminating patient related information
  • Responsive to ever-changing matrix of hospital needs and contractual obligations
  • Proficient in typing and able to work in various IT environments
  • Self-motivator, critical thinker, and able to work independently in a fast paced, high stress environment
  • Proficient in Microsoft Office programs such as Outlook, Word, and Excel
  • Capable of communicating professionally and effectively in English, both verbally and in writing
  • Minimum of 1 year of experience in Patient Financial Services department or a related area such as registration, finance, collections, customer service, medical office, contract management, or utilization management
  • High School diploma or GED (Preferred)


Licensure, Certification, or Registration Required:

  • N/A


Job Responsibilities:

Demonstrates through behavior Florida Hospital’s Core Values of Integrity, Compassion, Balance, Excellence, Stewardship and Teamwork as outlined in the organization’s Performance Excellence Program

  • Maintains performance standards by obtaining authorization information or verifying authorizations are in place for all inpatient and observation patient accounts as required, meets timeline standards established by leadership and contractual or governmental regulations for all patient service lines.
  • Conducts diligent follow-up on inpatient and observation authorization accounts with third party payers to minimize authorization related denials through phone calls, emails, faxes, and payer websites, updating documentation as needed.
  • Utilizes Cerner and Sunport to prioritize and work accounts for authorization resolution.
  • Meets or exceeds audit accuracy standard goal determined by Utilization Management leadership. Ensures integrity of patient accounts by entering appropriate and accurate data. Responsible for denial notification to clinical counterparts, meeting strict timely notification standards.
  • Verifies that authorizations are consistent with admission levels and documents clear, accurate, precise, and detailed account memos to ensure expeditious processing of patient accounts.
  • Maintains a close working relationship with clinical partners within Care Management/Utilization Management to ensure continual open communication between the departments. Contacts physicians and/or Care Management/Utilization Management to facilitate the sending of clinical information in support of the authorization to the payer, as required by contract.
  • Monitors e-mail inbox, faxes, and/or phone calls, responding to all related account issues within defined time frames. Exhibits effective time management skills in completing these tasks.
  • May assist team with reports and projects as defined by contract and/or regulatory requirements
  • Maintains a current, and thorough knowledge of utilizing online and system tools, working from manual reports during system downtime. Maintains sign-on access to online tools in order to provide consistent and timely authorizations as required by the third party payers.
  • Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receives information on account.

If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Utilization Management Authorization Representative opportunity with Florida Hospital and apply online today.



Job Keywords:

Utilization Management Authorization Representative, Utilization Management, Maitland



Position Location:  Maitland
Job:  Facilities Services / Housekeeping / Security
Organization:  Florida Hospital
Primary Location:  US-FL-Maitland
Schedule:  Full-time
Shift:  Day
Job Level:  Entry Level
Education Level:  None
Travel:  No
Job Posting:  Oct 9, 2018, 1:00:11 PM

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