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Part-time Utilization Review Assistant

at UnityPoint in Cedar Rapids, IA

Cedar Rapids St Lukes Hospital
FTE: 0.6, Part Time

Shift: Days


Description of Position:
Provide a “snapshot” or the principal purpose or focus of the position, consisting of no more than three to five sentences. This summary should provide enough information to differentiate the major function and activities of the position from those of other positions.
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.

Essential Functions/Responsibilities:
Essential functions are the duties and responsibilities that are essential to the position (not a task list). Do not include if less than 5% of work time is spent on this duty. Be specific without giving explicit instructions on how to perform the task. Do not include duties that are to be performed in the future. Duties should be action oriented and avoid vague or general statements.
% of Time
(annually)
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.

30 %
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.

30%
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.

30 %
Basic UPH Performance Criteria
· Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
· Demonstrates ability to meet business needs of department with regular, reliable attendance.
· Employee maintains current licenses and/or certifications required for the position.
· Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
· Completes all annual education and competency requirements within the calendar year.
· Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

10%
Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

Demonstration of UPH Values and Standards of Behaviors
Consistently demonstrates UnityPoint Health’s values in the performance of job duties and responsibilities
Foster Unity:
· Leverage the skills and abilities of each person to enable great teams.
· Collaborate across departments, facilities, business units and regions.
· Seek to understand and are open to diverse thoughts and perspectives.
Own The Moment:

· Connect with each person treating them with courtesy, compassion, empathy and respect
· Enthusiastically engage in our work.
· Accountable for our individual actions and our team performance.
· Responsible for solving problems regardless of the origin.
Champion Excellence:
· Commit to the best outcomes and highest quality.
· Have a relentless focus on exceeding expectations.
· Believe in sharing our results, learning from our mistakes and celebrating our successes.
Seize Opportunities:
· Embrace and promote innovation and transformation.
· Create partnerships that improve care delivery in our communities.
· Have the courage to challenge the status quo.

QUALIFICATIONS:

Minimum Requirements
Identify items that are minimally required to perform the essential functions of this position.
Preferred or Specialized
Not required to perform the essential functions of the position.
Education
High school graduate
Associates degree preferred

Experience:




Prior secretarial or commiserate experience in a medical environment preferred.
License(s)/Certification(s):

Valid driver’s license when driving any vehicle for work-related reasons.
Basic Life Support certification preferred.
Knowledge/Skills/Abilities:




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
Experience in Microsoft Word, Excel, Power Point and Outlook preferred.
Experience with Epic preferred.
Experience with insurance providers preferred.
Familiarity with medical terminology preferred.
Other:



Use of usual and customary equipment used to perform essential functions of the position.




SCOPE: Position has supervisory responsibilities? Yes ☐ or No ☒ If yes, complete below.
Number of Employees Supervised (Complete if position has supervisory responsibilities of individuals)


Budget Control (Complete if position has budget responsibilities)
Annual Operating Budget (including payroll)

Annual Revenue/Sales

Other Scope Measurements
Pertinent to the position, such as number of beds, number of units/departments, number of employees leading, cases per month, etc.
Item
Number




Mental/Cognitive Demands:
(List any special mental and cognitive abilities required by the position in your specific environment)
· Must be able to understand written, visual, and other sensory stimuli
· Must be able to cope effectively with stressful situations and time constraints
· Must be able to logically solve problems
· Must be able to follow complex written and verbal instructions

WORKING CONDITIONS:
Physical Requirements
(Check all that apply if essential to perform job – with or without accommodations)
☒ Talk/Hear (communicate, detect, converse with, discern, convey, express oneself, exchange information)
☒ See (defect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, assess)
☒ Stand or Sit (stationary position)
☒ Walk (move, traverse)
☒ Use hands/fingers to handle or feel (operate, activate, use, prepare, inspect, place, detect, position)
☐ Climb (stairs/ladders) or Balance (ascent/descent, work stop, traverse)
☒ Bend/Stoop/Kneel
☐ Squat/Crouch/Crawl
☒ Reaching/Twisting
☐ Taste/Smell (detect, distinguish, determine)
☒ Pushing/Pulling


Lifting Requirements
(Check appropriate category to perform job – with or without accommodations)
☐ Level 1; Sedentary Work: Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
☒ Level 2; Light Work: Exerting up to 20 pounds of force occasionally or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Requires walking or standing to a significant degree, pushing or pulling arm or leg controls or maintaining a production rate pace. Light work requires physical exertion of forces greater than that of sedentary work.
☐ Level 3; Medium Work: Exerting up to 50 pounds of force occasionally, and/or up to 20 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects.
☐ Level 4; Heavy Work: Exerting up to 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects.
☐ Level 5; Very Heavy Work: Exerting in excess of 100 pounds of forces occasionally, and/or in excess of 50 pounds of force constantly to move objects.


Hazards and Atmospheric Conditions
(check all that apply)
☒ Normal Office Surroundings
☐ Vibration
☐ Exposure to Fumes
☐ Mechanical Hazards
☐ Exposure to Dust
☐ Chemical Hazards
☐ Exposure to Extreme Temperatures
☐ Electrical Hazards
☐ Wet and/or Humid
☐ Radiant Energy Hazards
☐ Noise
☐ Explosives Hazards
☐ Mists or Gases
☐ Burn Hazards
Other/Comments:
Precautions must be followed when working in any health care environment.


OSHA Categories
(Complete this OSHA section for clinical/patient related jobs)
☐ Category I: Duties performed routinely require exposure to blood, body fluid and tissue.
☒ Category II: Normal routine involves no exposure to blood, body fluid or tissue, but exposure or potential for exposure may occur.
☐ Category III: Normal routine involves no exposure to blood, body fluid, or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.


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Published at 04-26-2017
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