Utilization Management Payor Specialist Part Time

The salary range for this position is $23.90 - $29.88 (Hourly Rate)

Placement within the salary range is dependent on several factors such as relevant work experience and internal equity. For positions represented by a labor union, placement within the salary range is guided by the rules outlined in the collective bargaining agreement.

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section located at jobs.nm.org/benefits to learn more.

Northwestern Medicine is powered by a community of colleagues who are purpose-driven and committed to our mission to deliver world-class care. Here, you'll work alongside some of the best clinical talent in the nation leading the way in medical innovation and breakthrough research with Northwestern University Feinberg School of Medicine.

We recognize where you've been, and we support where you're headed. We celebrate diverse perspectives and experiences, which fuel our commitment to equity and culture of service.

Grow your career with comprehensive training and development opportunities, mentorship programs, educational support and student loan repayment.

Create the life you envision for yourself with flexible work options, a Reimbursable Well-Being Fund and a Total Rewards package that support your physical, mental, emotional, and financial well-being.

Make a difference through volunteer opportunities we offer in local communities and drive inclusive change through our workforce-led resource groups.

From discovery to delivery, come help us shape the future of medicine.

Description

The Utilization Management Payor Specialist reflects the mission, vision, and values of Northwestern Memorial, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Responsibilities:

• Assists in the communication of clinical information provided by the Utilization Management/Denials Management Case Manager with all payors using a variety of methods, including faxing and verbal communication.
• Obtains timely payor determinations regarding certification of hospital stay and accurately records and conveys the determination to the Utilization Management/Denials Management Case Manager.
• Tracks and assures compliance with payor requests for information and communicates payor requests to Utilization Management/Denials Management Case Manager as needed.
• Documents and communicates denial information to the Utilization Management/Denials Management Case Manager.
• Provides feedback to Utilization Management/Denials Management Case Manager as needed regarding payor guidelines, issues, and determinations discovered during communication with payors.
• Ensures payor and customer satisfaction by utilizing effective communication and interpersonal skills.
• Provides entry, tracking, and trending of Quality and Documentation data and outcomes, as directed.
• Participates in Performance Improvement initiatives and performs other Case Management-related functions, as directed.
• Mails out appeals initiated by the Utilization Management/Denials Management Case Manager.
• Distributes and processes payor mail and faxes, including but not limited to, authorization and denial letters.
• Upholds the Northwestern Medicine policy on patient confidentiality.
• Assists with data preparation and the creation of presentation materials as needed for the Case Management Team.
• Scan all approvals and denial letters into Media tab in Epic.
• Follows up as needed with payor regarding pending appeal status.

Qualifications

Required:

• High school diploma
• Minimum of five years of healthcare experience
• Conversant with medical terminology
• Expertise and knowledge of third-party payor, Medicare/Medicaid guidelines

Preferred:

• Associate's Degree in healthcare related field
• Proficient in Case Management electronic systems (All Scripts system software, Epic)
• Utilization Management experience

Equal Opportunity

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.