Utilization Management Insurance Liaison - Hybrid opportunity

Are you looking to make a real difference in the lives of others in an empowering and supportive work environment? Join our growing and well respected community health system and enjoy competitive pay, high patient and staff satisfaction levels, excellent infection control support and compliance, free parking, tuition assistance and other excellent benefits!

Schedule: Full time, days Monday through Friday.

*This could be a hybrid opportunity however we will need the associate to be on-site at least 2-3 days per week.

Pay Range: $20.00 -$25.00, based on experience.

Benefits:

• Health, dental, vision insurance
• Tuition reimbursement up to $6000/year
• Contribution and match on Retirement Plan
• Four weeks paid time off
• Access to Success coaches
• Free parking

Company Culture: Thompson Health has a culture of empowerment. At Thompson, interdisciplinary teams come together to improve care, your suggestions are welcomed and your ideas are part of the solution. Three of our executives have an RN background so we understand the importance of the patient experience! 

• Focus on CARES values: Commitment, Action, Respect, Excellence, and Service
• Focus on Employee Wellness: Biometric screenings, Wellness programs, Onsite gym, Zen Room, Community Shared Agriculture program, Access to Success Coach
• Staff Recognition platforms: Shining Stars, CARESCount website

Main Function:

• The Utilization Management Insurance Liaison is responsible for managing the submission of clinical documentation to insurance companies for hospital admissions.
• This position tracks insurance approvals and denials, coordinates appeals and peer to peer discussions between the hospital providers and the insurance companies.
• This role ensures compliance with CMS regulations, NYS regulations and insurance company policies.
• This position acts as liaison to the business office and other hospital departments. 
• The Insurance Liaison supports the Utilization Management team by completing administrative tasks and assisting with coverage of select tasks when other members of the team are on vacation or leave. 

Required Job Specific Competencies:  

• Demonstrates understanding of state and federal regulations as pertains to Utilization Review and demonstrates familiarity with payer-specific guidelines.
• Demonstrates ability to work independently as well as part of team.
• Demonstrates the ability to develop and maintain collaborative working relationships with associates, leaders, medical staff and outside agencies.
• Exhibits flexibility in decision-making and prioritizes workload responsibilities.
• Demonstrates strong problem-solving, attention to detail and organizational skills.
• Demonstrates interpersonal skills, professional manner and excellent communication.
• High standard of medical & business ethics.
• Actively guards the confidentiality of sensitive information including but not limited to the patients, staff, and the health system.
• Demonstrates time-management skills with the ability to multi-task and meet deadlines..
• Demonstrates ability to use many software products including EHRs, Microsoft products, and other software/programs to assist with data analysis.
• Demonstrates comprehensive knowledge of insurance plans, member eligibility, medical billing with understanding of CPT, ICD-10 and medical terminology.

Qualifications:

• High School Graduate or equivalent required.
• Associate or Bachelor’s degree preferred.
• 1-3 years’ experience in a healthcare environment required.
• Strong computer, communication & organizational skills
• Previous experience reviewing and analyzing denials, claims and rejections preferred.
• Previous experience with reimbursement systems, DRGs/APCs, medical billing CPT codes, ICD10 coding guidelines preferred.

Pay Range: $20.00 -$25.00

Starting Rate: Based on experience

Thompson Health is an EOE encouraging individuals with disabilities and veterans to apply