**NO EXPERIENCE NECESSARY- WE WILL TRAIN**
Do you want a career where you can make a difference? Allegiance is a growing company with hometown values that is looking for dynamic candidates to join the team! A positive, team-oriented environment is provided with opportunities for advancement.
Allegiance offers full-time positions with evenings, weekends, and holidays off and a multi-faceted benefits package.
We pride ourselves in having a reputation for top-notch customer service. Make a difference. Start your career with Allegiance today!!
POSITION RESPONSIBILITIES:
The UM-IP Review Tech is responsible for the coordination and collaboration of the Inpatient Authorization process. The incumbent is expected to provide courteous and prompt preparation and responses for all referrals.
The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position.
ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions may be assigned as business conditions change.
- Reviews Inpatient Authorization requests received
- Determine if additional information is necessary. Contact provider and obtain additional information.
- If medical necessity not met
- Prepare package for clinical review
- Initiate and continue direct communication with health care providers involved with the care of the member to obtain complete and accurate information.
- Review IMR responses for accuracy and completeness and correspond with clinical staff as necessary.
- Coordinate with UM-IP Nurses to determined accurate documentation and clinical oversight on required reviews.
- Coordinate peer to peer appointments.
- Prepare & distribute Inpatient Authorization response letters in required timeframes.
- Meets service standards for decision turn-around times and written correspondence
- Initiate referrals for Case Management when appropriate
- Contributes the daily workflow with regular and punctual attendance.
- Maintain general clinical knowledge and skills through the attendance of available Internet education or conference calls, written works, or other similar resources and share knowledge with others
- Ensure accurate coding using current CPT and ICD codes and document all information accurately.
- Assist in managing incoming fax queue
- Initiate and receive phone calls related to Inpatient admissions and continued stay reviews.
NON-ESSENTIAL JOB FUNCTIONS:
- Performs related or other assigned duties as required or directed.
SUPERVISION EXERCISED:
None
PHYSICAL WORKING CONDITIONS:
Physical requirements are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Sitting 80%
Reaching Some
Standing 10%
Manual Dexterity High
Walking 10%
Telephone Yes
Kneeling Some
Computer Screen High (visual acuity corrected to 20/30)
Bending Some
Lifting up to 20 pounds
JOB SPECIFICATIONS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Education: High school graduation or GED required. Bachelor’s Degree preferred
Minimum Experience: Medical terminology and medical coding experience preferred, Previous experience in Behavioral Health/Mental Health preferred.
Other Qualifications:
- Excellent oral and written communication skills required.
- PC skills, including Windows and Word. Must be able to adapt to software changes as they occur.
- Typing ability of 45 wpm net.
- Knowledge of medical terminology and basic health insurance concepts.
- Excellent listening skills.
- High level of interpersonal skills to work effectively with others.
- Ability to organize and recall large amounts of detailed information.
- Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations and make appropriate applications to specific situations.
- Ability to identify errors/oversights and make corrections.
- Ability to project a professional image and positive attitude in any work environment.
- Ability to comply with privacy and confidentiality standards.
- Ability to be flexible, work under pressure and meet deadlines.
- Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions.
- Ability to operate typical office equipment.
- Working knowledge of general office procedures.
- Basic mathematical skills.
