Location/Department: Hospital - Cardiopulmonary/Quality (This is a shared position 50/50)
80/pp - 50% Cardiopulmonary Clerk & 50% UR Document Specialist
Job Summary: Cardiopulmonary Clerk
Performs clerical functions, facilitates communications, assists with patient care, processing of diagnostic test reports, and maintaining electronic health records (EHR).
Supervisory Responsibilities: None
Duties/Responsibilities:
- Restocks supplies to par level
- Orders supplies, linen, stock items
- Cleans & sets up room for patient.
- Demonstrates awareness of patient rights
- Assists patients into exam rooms, prepares patient for exam, & assists with patient discharge.
- Schedules appointments & procedures as needed utilizing dept scripting.
- Takes accurate messages, determines appropriate call direction.
- Retrieves & responds to voicemail messages.
- Faxes test results & correspondence.
- Organizes electronic test results for physician interpretation.
- Retrieves files & files records accurately.
- Compiles daily & monthly statistics as assigned.
- Supports interdepartmental workflows.
- Logs, copies, & distributes records & reports.
- Integrates use of EHR system into workflow.
- Transcribes orders accurately & promptly.
Required Skills/Abilities:
- Strong customer service skills.
- Effectively communicates both verbal & written with physicians, staff & guests.
- Strong organizational skills to ensure accuracy & orderly flow of exams & procedures scheduled.
- Able to multi-task & prioritize; works independently.
- Able to operate basic office equipment & hospital applications.
Education and Experience:
- Minimum high school diploma or equivalent.
- No prior work experience required.
- Certification in American Heart Association Basic Life Support for Healthcare Provider
Physical Requirements:
- Constant use of hands & talking; frequent walking, sitting, & manual dexterity; occasional pushing, pulling, climbing, stooping, kneeling, standing & reaching.
- Occasionally may need to lift up to 25 lbs
Job Summary: UR Document Specialist
The purpose of Utilization Review is to work towards the effective utilization of care services and appropriate reimbursement. Work is varied and requires attention to detail, initiative and decision making. Requires considerable tact and handling communications in an understanding, professional manner. The daily work includes communicating with other members of the healthcare team, obtaining and/or following up on authorization for services from third party payers, updating the electronic health record as needed, and capturing payer requirements as new information is discovered. Works closely with patient access, physicians, other members of the healthcare team, third party payers, and surgical provider offices.
Supervisory Responsibilities: None
Duties/Responsibilities:
- Review daily patient lists for new, continued stay, & discharged inpatients & observations.
- Note primary & secondary insurance for each patient.
- Contacts insurance companies to authorize hospital services, submit clinical & medical necessity criteria via portal or fax, & document approval/denial.
- Assisting UR nurse to provide additional clinical as directed or requested.
- Maintains knowledge of prior authorization/ precertification requirements & criteria for various payers.
- All above processes done in timely, efficient manner.
- Maintain daily huddle communication schedule.
- Assists with appeal process, including the coordination of provider peer to peer review with the payer on behalf of patients and/or hospital based on payer guidelines.
- Prepares correspondence & obtains medical record information as needed & forwards to appropriate payer.
- Attends & contributes to multidisciplinary teams as assigned.
- Corrects appropriate charges and places chart holds when necessary.
Required Skills/Abilities:
- Strong data entry & communication skills
- Experience with interpreting medical record information
- Critical thinking skills, detail oriented
- Must be able to operate a computer & other basic office equipment
Education and Experience:
- Minimum high school diploma or equivalent
- 2 years relevant experience with pre-certs/prior auths in a healthcare setting preferred
Physical Requirements:
- Frequent sitting, talking & use of hands
- Occasionally may need to lift up to 25 lbs