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Preauthorization Utilization Review Coordinator Print |
Employer: Sioux Falls Specialty Hospital
Location: Sioux Falls, SD 57105
Employment Type: Full Time
DESCRIPTION

Sioux Falls Specialty Hospital seeks a full time Preauthorization Utilization Review Specialist to join its growing team in providing personal and innovative care in a patient-centered medical environment. The Preauthorization Utilization Review Specialist is responsible to verify appropriateness of treatment and length of stay in facility to comply with government and insurance reimbursement policies in accordance with the organization’s Mission, Values and Standards of Performance.


KEY RESPONSIBILITY AREAS:



  • Review patient records/coverage to comply with government and insurance reimbursement policies upon registration.


 




    • Completes visit identifications for all surgical, imaging and pain management services.

    • Verifies benefits and obtains authorizations for patients from insurance companies/payor organizations.

    • Calls patients/parents to verify demographics.




  • Verifies insurance authorizations to ensure proper payments.



  • Discusses collection of deductibles and copays with patients.


 



  • Responds to phone calls from patients/parents regarding insurance coverage (i.e., calculating deductibles and out of pocket expense estimates; verifying coverage for dental cases).

  • Determines insurance requirement orders for Recovery Care patients and communicates information and any issues to nurses. Ensures proper medical signatures on orders.

  • Provides and calculates estimates to patients and clinics for charges for self-pay and cosmetic procedures for OR patients. Sets up self-pay payment arrangements.

  • Provides orders to Anesthesiology for all in-patient stays.

  • Provides orders, diagnosis codes and demographics to labs.

  • Assists clinics to ensure insurance companies are in-network prior to scheduling.

  • Stays current on insurance changes.

  • Attends and participates in staff meetings.2.     Assist with patient discharge and review patient coverage for extended stays.

  •  

  • Contacts insurance companies when patients are admitted to Recovery Care and when a patient requires a longer stay to verify coverage and benefits.

  • Gathers required clinical information and communicates patients’ progress to insurance company to receive authorization for continued stay.

  • Communicates insurance coverage information to appropriate staff to assist in discharge planning efforts.

  • Provides discharge dates and relevant clinical discharge information to insurance companies.

  • Assists billing in collecting additional information for appeal of denied claims.

  • Provides discharge planning nurse with patient’s insurance coverage information for Swing Bed and nursing home transfers.

  • Obtains signatures from overnight Medicare patients on post-op day two and informs them of their rights.3.   Provide support for registration system.

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  • Troubleshoots issues in registration system.

  • Tests upgrades.

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JOB SPECIFICATIONS:



  • Education and Experience



  • Knowledge of medical terminology and insurance processes desirable.



  • Lay person CPR.


 


 



  • Knowledge, Skills and Abilities


 



  • Technical competence to use computers and software utilized by the organization.

  • Excellent communication skills.

  • Ability to multi-task and handle stressful situations.

  • Problem-solving skills.


 


At Sioux Falls Specialty Hospital you will work in a caring environment with a growing hospital. We strive to create an atmosphere of respect, integrity, compassion and excellence for all of our patients and employees, and provide an exciting company culture and competitive salary package to the right candidate. Our benefits package includes medical, dental, vision, disability, a 401K and more. We are proud to be physician owned and operated.


We are committed to hiring skilled, compassionate professionals that share our vision for innovative, personalized patient care. We are an EO employer – Minority/Female/Veteran/Disability.


If you are interested in joining our team, please submit an application


ONLINE:
www.SFSH.com/CAREERS
OR:
SIOUX FALLS SPECIALTY HOSPITAL
ATTN: HUMAN RESOURCES
910 E 20TH STREET
SIOUX FALLS, SD 57105
EMAIL: HR@SFSH.COM
FAX: (605) 444-8410

REQUIREMENTS

Contact Information

Sioux Falls Specialty Hospital
910 E 20th Street
Sioux Falls, SD 57105

Other Information

Category(s): Health Care - Office, Healthcare, Admin & Clerical
Industry: Healthcare / Health Services
Experience Req.: Yes
Degree Req.: No
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