Utilization Management Support Specialist – Utilization Management – Maitland at AdventHealth

Date Posted: 7/11/2019

Job Snapshot

  • Job Schedule
  • Location:
    Maitland, FL
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Family
    Administrative / Business Support
  • Travel
  • Shift
  • Application Zone
    2-Legacy System
  • Organization
    AdventHealth Central Florida

Job Description

Utilization Management Support Specialist – Utilization Management – Maitland

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

Facility Profile:

Established in 1908, AdventHealth 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:

M-F, 8a-5p

Job Summary:

Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. Under supervision by the Director of Utilization Management and in communication with Patient Financial Services/Pre-Access team supports the AdventHealth annual Utilization Management Plan. Adheres to the rules and regulations of all commercial and government payers in fulfilling daily work assignments.

Knowledge, Skills, Education, & Experience Required:

  • Ability to communicate effectively in written and oral form with diverse populations and uses discretion when discussing personnel/patient related issues
  • Interpersonal skills to promote teamwork throughout the UM team
  • Ability to multitask and function in a fast-paced environment; Ability to prioritize and problem solve
  • Self motivated and able to work with teams on all 8 campuses
  • Analyze insurance/denial related issues within the department and effectively communicate to the team what needs to be addressed
  • Work within very tight time frames
  • Proficient in Microsoft Word, Excel and Outlook (Preferred)
  • Associates degree (Preferred)
  • Experience in health care, hospital setting, and/or Patient Finance Services (Preferred)

Licensure, Certification, or Registration Required:

  • N/A

Job Responsibilities:

Demonstrates through behavior AdventHealth’s Core Values of Keep Me Safe, Love Me, Make it Easy, and Own it as outlined in the organization’s Performance Excellence Program.
  • Audit and filter daily fax, Medicaid, UM worksheet and OR schedules to begin workflow for RN’s by 7am. Send all UM RN’s their daily assignments. Fax all campuses their daily report for their Medicare assignments. Monitor all Campus DRG and Government payer accounts and update accordingly and assign reviews to the team as required.
  • Monitor event codes/work flows from PFS, PA and/or Billing and work accordingly. Run PFS report every 30 minutes to an hour and turn on faxes as needed; must also page appropriate staff in response to this report such as RN, DCP, CM Manager and Directors. Expedite review of accounts needing immediate attention from RN UM team. Monitor and assign all concurrent in-house denial pages and follow up with team until the denial review is completed. Create denial letters when requested and submit to financial counselors for distribution.
  • Utilize mastery of computer systems and EMR required for UM work flow. Fax online data for appropriate accounts based on payer requests. Respond to specific fax requests from the payer for additional data on accounts that will require either a page to the RN, online data or a call back to the payer.
  • Monitor and document all e-mails and questions from PFS, PA, and Billing and respond back with answer via e-mail or phone. Responsible for the UM voicemail box that receives all messages specific to UM for all 8 campuses.
  • In compliance with CMS rules and regulations; Compile Medicare appeal packets pursuant to the Medicare RN Coordinator instructions when requested.
  • Creates agenda for the UM team meetings, and maintains the conference call relationship with the provider. Attends inter-departmental meetings as requested by the Director.
  • Creates and maintains the department master schedule, including PDO’s in direct communication with the UM Director. Maintains a Director spreadsheet of all employee absences.
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 Support Specialist opportunity with AdventHealth Maitland and apply online today.

Job Keywords:

Utilization Management Support Specialist, Utilization Management, Maitland

Position Location:  Maitland
Job:  Administrative / Business Support
Organization:  AdventHealth Central Florida
Primary Location:  US-FL-Maitland
Schedule:  Full-time
Shift:  Day
Job Level:  Entry Level
Education Level:  None
Travel:  No
Job Posting:  Jul 11, 2019, 12:07:58 PM

Location | Organization | Category | Job Function