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*Description*

Summary:

Coordinates inpatient denials for the hospital with emphasis on data management and reporting. Coordinates and manages all Utilization Review activities and works collaboratively with a multidisciplinary approach with other departments in an effort towards meeting financial goals and continued accountability. Coordinates department operations and serves as front line liaison for department.

Responsibilities:

* Coordinates inpatient denials for the hospital.

* Organizes utilization review activities.

* Coordinates workflow within the department and throughout the network.

* Liaises with other Revenue Center departments for problematic denials.

* Coordinates UR reimbursement in an accurate and timely manner.

* Works proactively with the Commercial payers to escalate denials with specific system-limited and time sensitive issues.

* Assists in timely sorting and disseminating requests for medical information from insurers and other sources to the case managers and physician advisor.

* Obtains Medicaid & Managed Medicaid Authorization for patient transportation.

* Edits and approves PI payroll.

* Manages department calendars.

* Tracks and monitors department expenditures and reconciles expenses and vouchers.

* Maintains and Models Nuvance Health Values.

* Demonstrates regular, reliable and predictable attendance.

* Performs other duties as required.

*Education Skills Experience*

* High School diploma

* 2 years clerical/computer experience required

* Knowledge of insurance protocols preferred

* Knowledge of medical terminology

* Excellent organizational, verbal and written communication skills

*License, Registration, or Certification Requirements:*

* Notary Public

Working Conditions:

Manual: significant manual skills/motor coord & finger dexterity

Occupational: Little or no potential for occupational risk

Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force

Physical Environment: Generally pleasant working conditions

Company: Northern Dutchess Hospital

Org Unit: 1157

Department: Care Coordination

Exempt: No

Salary Range: $20.86 - $38.73 Hourly

We are an equal opportunity employer

Qualified applicants are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other classification protected under applicable Federal, State or Local law.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation or our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to ensure that you are considered for current or future opportunities.