Utilization Management Insurance Liaison

Role Overview

• Responsible for managing the submission of clinical documentation to insurance companies for hospital admissions
• Track insurance approvals and denials, coordinate appeals and peer to peer discussions between hospital providers and insurance companies
• Ensure compliance with CMS regulations, NYS regulations and insurance company policies
• Act as liaison to the business office and other hospital departments
• Support the Utilization Management team by completing administrative tasks and assisting with coverage of select tasks when other members of the team are on vacation or leave

Requirements

• High School Graduate or equivalent required
• Associate or Bachelor’s degree preferred
• 1-3 years’ experience in a healthcare environment required
• Strong computer, communication & organizational skills
• Previous experience reviewing and analyzing denials, claims and rejections preferred
• Previous experience with reimbursement systems, DRGs/APCs, medical billing, CPT codes, ICD10 coding guidelines preferred

Benefits

• Health, dental, vision insurance
• Tuition reimbursement up to $6000/year
• Contribution and match on Retirement Plan
• Four weeks paid time off
• Access to Success coaches
• Free parking