Inpatient Utilization Review Technician

FLSA Status

Job Role Summary

Essential Functions and Responsibilities

• Proactively contributes to Eskenazi Health's mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County. Models Eskenazi's values of Professionalism, Respect, Innovation, Development and Excellence.
• Interacts with all internal and external customers in a caring and respectful manner in accordance with Eskenazi Health Services' Core Values.
• Performs pre-certification activities related to inpatient services in accordance with predetermined departmental criteria.
• Acts as a patient information liaison between business partners and contracted vendors.
• Handles a variety of confidential data and documentation involving Transition Support Department Utilization Review members, patients and physicians; as well as confidential departmental and hospital information.
• Interfaces with Transition Support staff, providers, and specialists to assist in problem-solving.
• Maintains open communication regarding current status of departmental operations.
• Operates within program requirements in accordance with CMS standards.
• Determines validity of coverage following established authorization requirements and refers to the UR Case Manager for further determinations of coverage, as needed.
• Compiles data for confidential/statistical reports.
• Performs administrative duties for respective work area in a wide variety of non-routine situations.
• Receives and screens phone calls, directing them to the UR Case Manager when appropriate.
• Responds to inquiries regarding benefits and authorizations, etc.
• Receives and maintains departmental files and records.

Job Requirements

• High school diploma or General Equivalency Diploma (GED)
• 1-2 years of experience in a healthcare-related position preferred
• Knowledge of computer and related software
• Medicaid experience preferred
• Ability to discern numbers and names, paying specific attention to detail to ensure accuracy in data entry
• Works as an effective team member
• Knowledge of general office procedures and mandated retention periods for pre-services
• Proficiency in document imaging processes, oral and written communications, customer service, and organization

Knowledge, Skills & Abilities

TBD