Utilization Coordinator (Team Lead) - Business Office - Lawrenceville, GA (Administrative)
Job Title: Utilization Coordinator (Team Lead)
Job Code: RCT071/Compliance Monitor 2
Shift: Full-Time (40 hours per week on average)
Job Hours: Times May Vary
Base Location: Lawrenceville, GA
Division/Department/Program: Revenue Cycle/ Business Office
The Utilization Coordinator Team Lead is responsible for supervising the day-to-day operation of the Utilization Management team. The Utilization Coordinator improves and monitors process/workflows and serves as a liaison between the Revenue Cycle team, HI and program staff.
Duties & Responsibilities:
Performs daily tasks with minimal supervision.
Serves as the lead to the Utilization Management team.
Provides support, feedback, training, and monitoring related to the completion, correction, submission and appeals of service authorization requests.
Manages assigned Revenue Cycle tickets.
Prepares reports to track authorizations, failed claims/activities, and to perform additional EHR monitoring and provides recommendations for program improvements.
Identifies trends, areas of improvement and provides training for program staff.
Collaborates with Revenue Cycle, HI and program staff in the development and monitoring of corrective action plans, as assigned.
Provides support and coverage, as needed within the Revenue Cycle team.
Provides follow up support for program staff to assess training needs and coordinate with Program Manager/Directors to facilitate additional support/training.
Attends agency and statewide meetings as needed.
Monitors Revenue Cycle support requests for trends in CareLogic errors and collaborates with Revenue Cycle, HI and UM to develop training, materials, and workflows for staff.
Reviews authorization submissions and EHR reports to identify trends and troubleshoot errors.
Monitors unresolved errors and notifies clinical and billing staff immediately of corrections needed. Reviews ERO standards and programmatic requirements (e.g., admission criteria, clinical exclusions, billing and documentation requirements) to ensure compliance, corrections and training needs are met.
Shares information with responsible program staff and assists in formulating plans for correction/training. Assists staff 1:1 as needed to correct isolated problems.
Maintains a good working relationship with physicians/clinicians/admin support/business office and programs to keep them informed about rules and regulations.
Acknowledges and responds to requests for information or support in a timely manner.
Attends regular agency and program staff meetings to disseminate information and provides support.
Knowledgeable in documentation and service coordination standards.
Other duties as assigned.
Minimum Qualifications:
High School Diploma or GED with three (3) year experience in a technical job related to the area of assignment. May require a valid driver's license.
Preferred Qualifications:
In additional to the minimum qualification:
Bachelor's degree in counseling, social work, psychology, or closely related field AND 2 years of professional experience in a Behavioral Health/Addictive Disease/Intellectual Developmental Disabilities setting.
Knowledge of DBHDD provider manual and guidelines.
Proficient use of CareLogic or other Electronic Health Record systems.
Proficient understanding of authorization processes.
Proficient use of Microsoft applications (Excel, Power Point).
Ability to multi-task and initiative to problem solve.
Ability to work well in a team environment and independently.
Experience working with Microsoft Excel Spreadsheets
Excellent communication, time management, and attendance skills
Requirements/Competencies:
Must be able to lift 20 pounds.
Requires long periods of sitting/standing.
Must have valid Georgia driver's license and Motor Vehicle Record in accordance with company policy.
Candidates for selection must pass a criminal background check (including fingerprinting).
Must pass a pre-employment drug screen and subject to random drug screens.
Any combination of training and experience, which would have enabled the applicant to acquire the necessary knowledge, skills and abilities Note: Some positions may require a valid driver's license.
Other duties as assigned.
Benefits (for qualified employees):
State Health Benefits Package (medical, dental, vision, life insurance, disability, long-term care, legal services, flexible spending accounts)
Paid New Hire Training
Company contributes additional 7.5% of salary to 401(a) Retirement Plan
No employee deduction for Social Security
Additional benefits such as legal services, Employee Assistance Program and discounted tickets to attractions, shopping, technology and travel
Supervision, training, and continuing education opportunities available
View Point Health is an Equal Opportunity Employer: View Point Health recruits qualified candidates for positions in View Point Health programs throughout its service area. It is the policy of View Point Health to provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination or harassment of any type without regard to race, color, sex, religion, national origin, age, disability, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
