Outpatient Utilization Review Tech

Responsibilities:

Manages client’s authorizations(units/sessions) for therapeutic services and submits requests for additional authorizations as needed utilizing clinical information contained in the client’s electronic medical record and communicates authorization information and requirements to the appropriate clinical and/or administrative staff.

Assists Office Managers with obtaining initial Primary Care Physician Referrals as needed and obtains continuing Primary Care Physician Referrals.

Manages Failed Claims daily, working with various individuals and departments to make corrections.

Assist with verification of Medicaid eligibility and commercial insurance benefits for clients in assigned programs as needed and directed by Outpatient Administrator.

Completes UR Admissions/Discharges in the electronic medical record for clients enrolled in outpatient programs.

Participate in and provide assistance with audit activities as needed.

Communicates with outpatient staff to coordinate responsible provision of services.

Assists with preparing documentation for appeals and hearings with Medicaid, PASSEs and commercial insurance companies as needed.

Prepares and maintains appropriate records and/or documents and submits reports as required.

Qualifications:

· Bachelor’s Degree in Social Work or related field preferred; relevant work experience may be substituted for education.

· One-year UR experience, or related field; knowledge of Arkansas Medicaid and PASSE systems and experience requesting prior authorizations/benefits is preferred.

· Good writing skills, verbal skills, computer skills, and experience with Microsoft applications.

· Good communication and people skills.

· Must be organized and detailed-oriented.

Additional Mandatory Requirements:

· Ability to document accurately and professionally

· Must be physically capable to receive verbal and written directions

· Remains current in Crisis Prevention Intervention Training, CPR & First Aid

· Must be willing and able to work with all patients of Methodist Family Health, regardless of gender

· Must have good auditory, visual and olfactory ability

· Use hands and fingers to handle or feel objects, tools or controls

· Must be able to maintain effective audio, visual discrimination and perception needed for making observations, communicating with others, reading and writing, and operating office equipment and other treatment equipment.

· Must be able to use a telephone to communicate verbally and a computer to communicate through written means, to review information and enter/retrieve data, to see and read characters on a computer screen, chart or other treatment items

· Requires the ability to sit for long periods of time and intermittently walk, stand, stoop, kneel, crouch and reach with hands and arms.

· COVID-19 vaccination and Flu vaccination are mandatory and required for all positions (subject only to qualified exemptions).

Other: The individual employed in this position may accept other reasonable assignments, which may be necessary, for efficient operation of assigned programs as there is time andopportunity.

Job descriptions are not intended, nor should be construed, to be all-inclusive lists of all responsibilities, skills, efforts or working conditions associated with a job. While this job description is intended to be an accurate reflection of the job requirements, management reserves the right to modify, add or remove duties from particular jobs and to assign other duties as necessary.

Level One - Full Access: Ongoing regular access to PHI of all forms while the employee is on duty and performing within the scope of his or her job as defined by the employee's job description, and Policy and Procedure. "Such access must be for cause, consistent with job responsibilities and related to patients, claims, audits, reviews and other legitimate business purposes." (e.g. Physicians, nurses and other clinicians)