Utilization Management Insurance Liaison

Role Overview

• Managing the submission of clinical documentation to insurance companies for hospital admissions
• Tracking insurance approvals and denials
• Coordinating appeals and peer to peer discussions between the hospital providers and the insurance companies
• Ensuring compliance with CMS regulations, NYS regulations and insurance company policies
• Acting as liaison to the business office and other hospital departments
• Completing administrative tasks and assisting with coverage of select tasks when team members 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