Utilization Review Analyst Jobs (NOW HIRING)

GENESIS HEALTHCARE SYSTEM
In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an 'owner' of Genesis and keep our patients at the center of everything we do - always.
Position Details:
Work Shift:
Day Shift (United States of America)
Scheduled Weekly Hours:
40
Department:
Utilization Management
Overview of Position:
The Utilization Review (UR) Analyst is responsible for assuring insurance notification, authorization/precertification of the patient's hospitalization is complete and accurate. The UR Analyst gathers, interprets and uses insurance, patient demographics and clinical information and takes actionable steps to improve and optimize the utilization review process. They assure timely coordination of all patient information to the payor and tracks and records authorization responses in EPIC. Works with insurance verification associates, billers, physicians, and patients to analyze and resolve payor authorization problems in order to assure timely reimbursement. Works with Utilization Review Nurses to analyze denials and appeal hospitalization stays in a timely and efficient manner.
ESSENTIAL DUTIES
1. The UR Analyst gathers insurance, demographics, clinical information. They assure all clinical reviews are submitted to third party payors for timely and accurate certification for medical necessity, status, level of care, and any updates of information from the time of admission/observation through the time of discharge. Prioritizes and responds in a timely manner to third party request for concurrent and continued stay reviews and sharing of clinical information.
2. The UR Analyst interacts with key stakeholders and strives to identify improved technological ways to gather patient information / clinical reviews and speed the flow of information to payors, billers, and physicians across the care continuum. They gather feedback from end users to continue improving systems, the process and flow of information. They assure information is submitted within time frames established by payor and hospital contracts
3. The UR Analyst is responsible for analyzing the Case Management financial billing work-que. They analyze, identify trends and efficiently solve problems in order to resolve cases and payor issues.
4. The UR Analyst can demonstrate critical thinking skills is able to submit basic cases, yet examines and identifies appropriate cases that need to be escalated to the registered nurse for further review and analysis, prior to submission of information to payors.
5. Works closely with the registered nurses and manager to analyze denials, identify trends, appeal cases and continually strive for improved financial outcomes.
6. Ensures that all cases are processed and are compliant with rules and regulations of our government and third-party payers.
7. Checks payer websites subscribes to list serves where applicable and is accountable to obtain necessary information from payer/website. Uses information accurately and effectively.
8. Demonstrates understanding of medical terminology and diagnosis with correct spelling.
9. Independently prepares daily reports and drafts correspondence involving synthesizing information, writing text and preparing final communications for distribution with a 98% error free result.
10. Completes and processes necessary paperwork according to procedures with a 98% accuracy rate. This includes preparing/distributing reports, contract maintenance, depart goals/report card, correspondence, memoranda, and meeting agendas/minutes.
11. Maintains an effective system for storing, filing and retrieving verifications, correspondence and reports to enhance efficiency.
12. Assist with department schedules, assignments and payroll, as needed.
QUALIFICATIONS
1. At a minimum, an Associate College Degree is required.
2. Analytic and technology skills which demonstrate critical thinking and problem-solving skills.
3. Knowledge of healthcare insurance, or prior experience of 2 years in a support-related position required.
4. Solid written communication skills are needed to assist in the preparation of reports and correspondence.
5. Basic math skills to perform operations including multiplication, division, calculating simple ratios and/or proportions.
6. Solid computer operations skills and sound working knowledge of basic office software products for word processing, graphic presentations, spreadsheet production and/or database operations.
7. Flexibility in handling changing work priorities and dealing with multiple priorities simultaneously.
PATIENT CENTERED CARE & BEHAVIORAL EXPECTATIONS
1. Living the Genesis Mission, Vision and Values
• Performs work in a manner that is quality focused.
• Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect.
• Results oriented and focused on achievement of objectives.
• Acknowledges and responds to the diversity of people and the situation.
• Encourages peers (others) to be owners of change.
• Always makes the effort to anticipate and exceed customer needs and expectations.
• Possesses the ability to engage others with patience and understanding.
• Acts in a manner that creates positive first and lasting impressions.
• Demonstrates the ability to own issues until they are resolved.
2. Patient Centered Care (patients/families, physicians, co-workers, all other internal/external customers)
• Introduces self and role...connects with everyone.
• Communicates effectively (i.e. advising others of actions, pertinent information, time durations, etc.) and asks for feedback.
• Asks for and anticipates needs and concerns of others.
• Maintains a positive work environment for staff and a healing environment for patients (i.e. safe, clean, quiet, etc.)
• Maintains the dignity and privacy of each person; manages confidential/sensitive information appropriately.
• Responds to requests in an appropriate and timely manner.
• Exits patient/customer encounters courteously, asking if there are additional needs that can be addressed.
3. Promotes Patient and Employee Safety
• Demonstrates safe Patient Handling (i.e. transfers, transport, care administration, nutrition, medication, etc.)
• Demonstrates safe Materials Handling (i.e. appropriate use and disposal of chemicals, infectious wastes, etc.)
• Demonstrates appropriate knowledge of Infectious Disease precautions and use of proper protective equipment
• Demonstrates Slips/Trips and Falls Awareness.
• Actively contributes to maintaining a safe, clean and quiet environment.
WORKING CONDITIONS/PHYSICAL REQUIREMENTS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Must have excellent written and verbal communication skills as well as the ability to observe, access, guide and evaluate others.
2. Must be able to hear, speak, see and to coordinate motor skills.
3. Must be able to climb, lift25 pounds, stoop and bend.
4. Ability to collect data, interpret findings, set priorities and carry out established plan.
5. Ability to read, write and utilize manual and computerized systems of documentation.
6. Must read a significant amount of information in a relatively short period of time.
Thank you for your interest in employment at Genesis. Genesis is committed to being an equal opportunity employer. Selection of applicants for employment is based only on qualifications and the requirements of a specific job.