Utilization Review Assistant - UnityPoint Health

Under the guidance and supervision of the utilization management nursing staff, the associate is responsible for the maintenance and utilization of Epic work queues that drive payer notification and authorization for patient stays.   The associate communicates with payers via telephone, fax, or email and is responsible for ensuring clinical requests are sent in a timely manner and in a thorough fashion.  The associate is expected to acquire an understanding of prior-authorization, verification, and benefit coordination for payers and proceeds with authorization and documentation as delegated.  The associate assists with patient notification regarding level of care and appeal rights per CMS regulations.  

Why UnityPoint Health?

• Commitment to our Team – For the third consecutive year, we're proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare for our commitment to our team members. 
• Culture – At UnityPoint Health, you matter. Come for a fulfilling career and experience a  culture  guided by uncompromising values and unwavering belief in doing what's right for the people we serve.
• Benefits –Our competitive  Total Rewards  program offers benefits options like 401K match, paid time off and education assistance that align with your needs and priorities, no matter what life stage you’re in.
• Diversity, Equity and Inclusion Commitment– We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.
• Development– We believe equipping you with support and  development opportunities  is an essential part of delivering a remarkable employment experience.
• Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve.

Hear more from our team members about why UnityPoint Health is a great place to work at  https://dayinthelife.unitypoint.org.

Administrative/Clerical Support

• Answers telephone: screens calls and callers, referring them to appropriate associate/department
• Maintains designated filing and record keeping systems. Assists with preparation of reports, graphs, and statistical information.
• Performs other related secretarial and clerical functions as requested.

Client/Customer Excellence

• Creates a welcoming environment for person’s served. Effectively manages positive relationships with referral sources and other members of the team.
• Manages and coordinates pre-authorizations for services as needed. Sends requested documentation to third party payers for prior authorization and reauthorization of patient visits.
• Monitors and completes accounts on multiple work queues in EPIC, including referrals and denials.

Regulatory Compliance

• Distributes notification letters to, provides education to, and secures signatures from patients per CMS regulations surrounding admission status and right to appeal discharge.

• High school graduate
• Writes, reads, comprehends and speaks fluent English.
• Keyboard accuracy/speed of at least 60 words per minute.
• Microsoft Office computer knowledge and skills.
• Multicultural sensitivity.
• Possesses courteous and effective telephone etiquette.
• Possesses ability to prioritize and maintains organization in essential functions/responsibilities
• Use of usual and customary equipment used to perform essential functions of the position.