Utilization Review Coordinator jobs in Winston Salem, NC

ESSENTIAL JOB FUNCTIONS:

Responsibilities:

• Maintains compliance with organizational policies and procedures.
• Demonstrates effective computer skills, files, answers phones in a timely and professional manner providing complete and accurate information, and provides other administrative duties as required.
• Accurately performs patient check in and check out procedures. Processes privileged patient health information (obtains current insurance verification and authorization), balances daily receipts, and responds to billing questions. Schedules patient appointments entering all required demographic and clinical information into the system and coordinating with other parties.
• Maintains compliance with established safety and regulatory guidelines, including HIPAA, OSHA, and infection prevention policies and procedures.
• Participates in unit performance improvement activities.
• Demonstrates good customer service skills when interacting with patients, families, and visitors. Exhibits effective communication skills and team work.

The following is a summary of the major essential functions of this job. The incumbent may perform other duties, both major and minor, that are not mentioned below; and specific functions may change from time to time.

People:

• Builds a strong, positive relationship with every customer served, both internal and external
• Works effectively with others to deliver the highest quality care and service on a continuous basis
• Follows HCMH standards of performance at all times

Quality

• Demonstrates skills and knowledge to effectively complete assigned tasks and completes all required education programs
• Delivers safe, accurate and timely patient care that conforms to HCMH standards and departmental goals and main job functions as outlined below
• Maintains strictest patient confidentiality.

Service

• Works diligently to meet every customer’s needs.
• Fully engaged, fully aware and available to help others while on duty
• Answers telephone, screens calls, routes calls appropriately.
• Maintains appointment scheduling and follows office scheduling policies. Reschedules appointments when necessary.
• Sets up medical record chart for new patients and enters patient demographic and insurance data into computer system; checking in patients, verifying and updating necessary information in the medical record and the computer; receiving payments and issuing receipts, posting payments and charges; verifying diagnosis and CPT codes as necessary.
• Generates encounter forms for scheduled and work-in patients as needed.
• Calls for authorizations from insurance companies as necessary.
• Fills out appropriate referral forms.
• Copies records to fax/mail to referring physicians.

Finance

• Accomplishes tasks with the minimum expenditure of time, materials and money with service as the guiding principle.

• Works productively while on the clock and offers to help others when work is completed.
• Reconciles accounts payable statements with invoices and receiving reports; prepares invoices for Accounts Payable.

Growth

• Demonstrates the ability to positively and productively respond to change.
• Participates in continuous improvement, offering and or implementing methods to improve care and service.

• Attends required meetings and participates in committees as required.
• Pursues professional development activities to ensure currency with present practices and trends in health care management.
• Performs related work as required.