Administrative Coordinator - Utilization Management (Roanoke, VA, US, 24014)

Company: Carilion Clinic
Location: Roanoke
Posted on: May 28, 2023

Job Description:

How You'll Help Transform Healthcare: Provides direct support to the Utilization Management team and workflow which directly impacts revenue for Carilion Medical Center and all Carilion regional facilities.

• Serves as a resource for UM Director, Managers, nurse reviewers and fellow team members. Collaborates with members of the UM and/or Care Management team to assist in meeting timely patient progression/ throughput needs. -
• Prioritizes and performs UM Coordinator duties to maintain workflow functions as primary responsibility or as back up and as applicable to the department. Monitors workflow/processes and relays recommendations for improvement to UM leadership.
• Gathers required clinical and demographic data for UM and Appeals cases and disseminates to appropriate recipients. -
• Maintains databases and spreadsheet files, ensuring accuracy, production and distribution. Keeps files and reports in a confidential manner.
• Manages Epic work queues -with appeals, denials and P2P data and tracks related data
• Serves as a resource/liaison with regard to payors, billing, Care Management staff, providers and outside vendors. Fields phone calls, voicemails and written correspondences via fax/email/inbox/USPS mail regarding benefits, coverage, insurance questions. -Disseminates these to appropriate UM Reviewer and documents actions taken.
• Arranges Peer-to-Peer (P2P) conversations between providers and payor liaisons.
• Aids in completion of federally mandated letters.
• On front line of appeals process, will be responsible for communicating -with payors, Carilion billing department and UM Reviewers for appeals case submission.
• Forwards appeal referrals to outside vendor for protected release -of information (ROI) and submits appeals electronically to payor portals. May require manual faxing and/or mailing of requested clinical information with appropriate ROI documentation.
• Maintains competence through continuing education, in-services, and attendance at staff meetings. -Performs other tasks related to the department workflow and participates in special department projects as assigned by the UM leadership team What We Require: Education: -Associate degree or equivalent combination of education or 2 years of experience required. Experience: -Two years experience in administrative support required. Experience in healthcare practice setting preferred. Other Minimum Qualifications: Advanced computer skills with knowledge of a variety of software programs, including Microsoft word, Excel, Access, word processing, spreadsheets and presentation or database software. - Excellent communications and organizational skills required. About Carilion This is Carilion Clinic ... An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious. Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute. Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us. Requisition Number: 140715 - Employment Status: Full time - Location: CRMH - Carilion Roanoke Memorial Hospital - Shift: Day/Evening - Shift Details: Primarily Day/Evening with occasional weekends. Recruiter: DANA E JOHNSON - - Recruiter Email: dejohnson@carilionclinic.org For more information, contact the HR Service Center at 1-800-599-2537. Equal Opportunity Employer Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity Carilion Clinic is a drug-free workplace.

Keywords: Carilion Clinic, Roanoke , Administrative Coordinator - Utilization Management (Roanoke, VA, US, 24014), Administration, Clerical , Roanoke, Virginia