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UR Authorization/Denial Support - Full time Day in Tampa, FL at AdventHealth

Date Posted: 4/13/2019

Job Snapshot

  • Job Schedule
  • Location:
    Tampa, FL
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Function
    Case Management
  • Travel
  • Shift
    1 - Day
  • Application Zone
    1-Shared Services
  • Organization
    AdventHealth Tampa

Job Description



UR Authorization/Denial Support - AdventHealth Tampa

Location Address: 3100 East Fletcher Avenue Tampa, Florida 33613
Top Reasons to Work at AdventHealth Tampa
  • Florida Hospital Pepin Heart Institute, known across the country for its advances in cardiovascular disease prevention, diagnosis, treatment and research.
  • Surgical Pioneers – the first in Tampa with the latest robotics in spine surgery
  • Building a brand new, six story surgical and patient care tower which will ensure state of the art medical and surgical car for generations to come
  • Awarded the Get With The Guidelines – Stroke GOLD Quality Achievement Award from the American Heart Association/American Stroke Association and have been recognized as a recipient of their Target: Stroke Honor Roll for our expertise in stroke care. We have also received certification by The Joint Commission in collaboration with the American Stroke Association as a Primary Stroke Center.
Work Hours/Shift:
FT / Day
You Will Be Responsible For:
  • Works with Insurance payers to ensure proper reimbursement on patient accounts to expedite resolution. Analyzes daily correspondence/work items to appropriately resolve issues. Immediately notifies the Case Management department and/or Authorization RN and/or Denials RN, as appropriate, of any inpatient denials and obtains information from the insurance carrier regarding their concurrent/retrospective appeal process. Documents all steps in patient account to ensure process flow is accurate.
  • Interacts with physicians, physician office personnel, and/or case management departments on an as-needed basis to assure resolution of pending denials, which have been referred to the physician for peer-to-peer review with the Medical Director of the Insurance carrier. 
  • Provides timely and continual coverage of assigned work area in order to ensure all accounts are completed.  Meets attendance requirements, and is flexible during periods of short staffing, and/or high volume.  Meets or exceeds accuracy standard goal determined by Leadership.
  • Maintains knowledge of all insurance plan requirements and basic authorization requirements for assigned payers, based on payer matrix. Ensures proper authorization by reviewing patient admission status within Cerner, and matching with the correct level of care authorization. Answers the department phone via dialer and responds to voice mail in a timely manner, routing calls to facilities as appropriate. Expedites communication with insurance contacts to assure timely authorization is received. Analyzes previous account documentation, in order to determine appropriate action(s) necessary to resolve each assigned account.


What You Will Need:

  • High School diploma or GED
  • Minimum two years’ experience registration or claims processing
  • Minimum two years’ experience with commercial insurance/authorization handling
  • Basic computer skills (ie. Word, Outlook, Excel, etc.)
  • Basic Medical Terminology

Job Summary:

Under the guidance of the Utilization Review Mgmt Director, this role works in collaboration with authorization/denials RNs and under the general direction of the Director of Utilization Review. This role is responsible to properly verify benefits, obtain authorizations, and perform assigned tasks within 72 hours of the admission date (ER visits) or earlier if possible. Upholds accuracy and ensures proper authorization has been secured prior to or at the time of discharge for observation and inpatient stay visits. Able to multi-task and complete each account within 15 minutes or less. Possesses excellent telephone etiquette and professional speaking while speaking with patients, commercial payers, physician offices, team members, etc. Ensures all benefits, authorization requirements & status, and collection notes are obtained by working with commercial or managed care payers, documented clearly and thoroughly on accounts in the pursuit of timely reimbursement within certain established timeframes as determined by the Director. Maintains working knowledge of payer guidelines and have familiarity with payer processes for initiating authorizations and follows through accordingly to prevent loss of reimbursement. Actively participates in team workflows & 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.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Location | Organization | Category | Job Function