Outpatient Utilization Specialist

If you are a current University Health or University Health Physicians employee and wish to be considered, you must apply via the internal career site.

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The Utilization Specialist can be the first point of contact for many patients regarding financial clearance for their procedure or hospital stay. This position is responsible for providing a positive and inviting image to the patient and family.

The Utilization Specialist will verify all financial and insurance information, obtaining appropriate pre-certification and authorization, collecting copays and deductibles, completes all authorization/notification paperwork, and Assists with training new and existing staff and can be relied upon to lead and train staff in preparation for special projects.

They will ask key questions to help facilitate the prior authorization and scheduling process for specified procedures and Admission Notifications. Utilization staff will need to work with FCC Staff for all self-pay patients to review eligibility for the University Health Discount and/or Medicaid. The Utilization Specialist will be expected to communicate financial responsibility to the patient and communicate with clinics and/or physicians with any concerns. In some clinic settings Patient Responsibility will be communicated by the scheduler.

The Utilization Specialist is responsible for facilitating the flow of information between the clinical areas, Utilization Management, insurance company and the Patient Accounting Department as well as documenting all pertinent information in Revenue Cycle through the Enhanced Authorization Process.

Minimum Requirements

• High school diploma or equivalent.
• Experience in healthcare insurance verification and billing protocols.
• Two years' experience in face to face and/or customer service or equivalent field. Working knowledge of medical terminology, CPT codes, and ICD9 codes.
• Ability to type 30 wpm.
• Communication and customer service skills required to gather and exchange information with patients, families, hospital staff members, physicians and third party payers.
• Ability to work and think independently with limited supervision, ability to handle sensitive information, with discretion, great attention to detail, ability to handle multi-tasking and change in priorities.
• Working knowledge and efficiency in Microsoft products (Outlook, Word, Excel, Access, & Power Point).
• Willing to become familiar with other software programs.

Preferred Qualifications

Experience in Procedure Authorizations and Inpatient Admission Notifications

Prior Experience working with Clinicians or Utilization Management

Prior Experience in registration or working with insurance eligibility

Course work in medical terminology and coding.