Utilization Tech I

Saint Joseph Medical Center is a critical care hospital and ER with advanced specialty care services. Our flagship hospital in the Joliet area, Saint Joseph Joliet delivers specialty care and 24/7 emergency care. And, we have a level II trauma center. We provide advanced surgical care for serious and life-threatening injuries and illnesses. Our care teams listen to understand your health needs and deliver care that's right for you. Saint Joseph Joliet is a destination for specialty care - including heart, cancer, stroke care, orthopedics and women's health. Our OB-GYNs and maternity care teams deliver a personalized birthing experience and advanced neonatal care for sick babies. We offer a wide range of minimally invasive procedures using robotic-assisted technology, imaging and lab tests, a dedicated inpatient rehabilitation center, all on one campus.

The Utilization Review Tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives.

Utilization review tech is responsible for coordinating phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals.
• Document and track all communication attempts with insurance providers and health plans and scan all related correspondence to the respective EMR/ tracking tool.
• Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers.
• The Utilization Review Tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned.
• The Utilization Review Tech will further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

1. High School Diploma or Equivalent.

2. Microsoft office proficiency.

3. Good communication skills

Preferred qualifications:

1. Completion of a medical terminology course; preferred.

2. Knowledge of HIPAA regulations preferred.

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