Utilization Review Tech II

Overview

St. Mary's General Hospital, located in Passaic, NJ, is a community-based tertiary medical center focused on providing quality, compassionate care. It is an acute care hospital providing a broad range of services including cardiovascular services as well as a comprehensive program for cancer care. The hospital is also a center of excellence for maternal-child health and outpatient behavioral health services. It is the only hospital in Passaic and with over 550 physicians and 1,000 employees, and is one of the largest employers in the county. Every member of the St. Mary's General team is committed to providing respectful, personalized, high-quality care. St. Mary's General Hospital is a member of Prime Healthcare, which has been lauded as a "Top 15 Healthcare System" by Truven Health Analytics. For information, visit .

Responsibilities

The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. The Utilization review tech will further support the department needs for Release of Information, discharge coordination or other duties as assigned.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

1. High School Diploma or equivalent required.
2. Associates degree or higher preferred.
3. Two years of relevant experience required
4. Accurate alphabetic, numeric, and/or terminal-digit filing skills.
5. Computer data entry with 10-key, with accurate typing speed of 35 wpm required. Excel skills highly preferred.
6. Knowledge of terminal digit filing and medical terminology; preferred.
7. Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.
8. Completion of a medical terminology course; preferred.
9. Background in business and office training; preferred.

Pay Transparency

St. Mary's General Hospital offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $16.30 to $24.93. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: