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UR Authorization / Denial Support - FT/Day

Req #: 18000365
Location: Tampa, FL
Job Category: Case Management
Organization: Florida Hospital Tampa
Potential Referral Bonus: $

Description
Work Hours/Shift

Full Time

Florida Hospital Tampa

Our hospital has celebrated many firsts in Tampa’s health care history since we opened our doors in 1968. Today, more than four decades later, Florida Hospital Tampa continues to offer innovative medicine as we elevate health care in the Tampa Bay region.

 

At Florida Hospital Tampa, our diverse clinical specialties provide world-class health care to our patients. We offer the most trusted, expert care in key specialties including cardiovascular care, neurosciences, orthopedics, women's health, cancer and surgery. Our skilled surgeons not only utilize minimally invasive and robot-assisted procedures, but they are also leaders in improving these advanced techniques.


You will be Responsible for:
  • Communicates with all customers (patients, families, staff, physicians, vendors, etc.) in a helpful and courteous manner while extending exemplary customer service.  Anticipates and responds to inquiries and needs in an assertive, yet courteous manner. Demonstrates positive interdepartmental communication and cooperation.
  • Reviews daily admission roster to assure insurance carrier has been contacted and determine if clinical review is required to obtain insurance authorization.
  • Receives all faxed requests for clinical information from payers, organizes and communicates to the appropriate member of the Case Management team.  Follows up to ensure clinical information has been communicate as requested.
  • Answers the department phone and responds to voice mail in a timely manner. Expedites Communication with insurance contacts to assure timely authorization is received. 
  • Monitors daily discharge report to assure all patient stay days are authorized. Follows up with insurance carrier to obtain complete authorization.
  • Maintains up to date concurrent authorization for in house patients.  Alerts Case Mangers for the need of concurrent or retrospective clinical information.
  • Assist in assuring proper patient status authorization, by reviewing patient admission status within the Cerner Care Manager system and matching with the correct authorization.
  • Communicates with the other departments/team members for resolutions of conflicts between status and authorization.
  • Immediately notifies the Case Manager and the Director of any inpatient denials and obtains information from the insurance carrier regarding their concurrent appeal process.
  • Interacts with Physicians, office personal on an as needed basis to assure resolution of pending denials, which have been referred to the physician for peer-to-peer review with the Medical Director of the Insurance carrier. 
  • Provides timely and continual coverage of assigned work area in order to ensure all accounts are completed   Meets attendance requirements, and is flexible during periods of short staffing, and or high volume. 
  • Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level before releasing account information.
Qualifications
What will you need?
  • Basic computer skills
  • Medical Terminology
  • Proficient in using multiple computer applications interchangeably
  • Communicates professionally with an acceptable use of English and spelling
  • Ability to follow directions
  • Works independently in most situations while multitasking
  • Capable of working with people of various diverse backgrounds
  • Customer service skills
  • High School diploma or GED (Preferred)
  • Prior experience with insurance/authorization (Preferred)

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
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