Utilization Coordinator (Remote) - Billing/Revenue Cycle - Lawrenceville, GA.

View Point Health

Job Title: Utilization Coordinator

Job Code: RCT071/Compliance Monitor 2

Shift: First – Full-Time (40 hours per week on average)

Job Hours: Times May Vary

Base Location: Lawrenceville, GA

Division/Department/Program: Billing/Revenue Cycle

The Utilization Coordinator reviews system reposts to determine state or program compliance or change in state or program guidelines. Improves and monitors process/workflows and serves as a liaison between Revenue Cycle Health Informatics (HI) and program staff. Examine documents to identify noncompliance with state policies and procedures.

Duties & Responsibilities:

• Provides support, feedback, training, and monitoring related to the completion, correction, submission and appeals of clinical/programmatic requests for service authorizations.
• Manages assigned Revenue Cycle tickets.
• Prepares reports to track authorizations, failed claims/activities, and to perform additional Electronic Health Record monitoring and provide recommendations for program improvements
• Identifies trends, areas of improvement and provides training for program staff as needed
• Collaborates with Revenue Cycle, HI and program staff in the development and monitoring of corrective action plans, as assigned
• Provides support and coverage, as needed within the Revenue Cycle team
• Provides follow up support for program staff to assess training needs and coordinate with Program Managers/Directors to facilitate additional support/training
• Attends agency and statewide meetings as needed
• Monitors Revenue Cycle support requests for trends in Carelogic errors and collaborates with Revenue Cycle, HI and UM to develop training materials and workflows for staff
• Monitors unresolved errors and notify clinical and billing staff immediately of corrections needed to ensure compliance, corrections and training needs are met
• Share information with responsible clinician/supervisor and assist in formulating plans for correction/training. Assists staff 1:1 as needed to correct isolated problems.
• Maintains a good working relationship with physicians/clinicians/admin support/business office and others to keep them informed about rules and regulations.
• Acknowledges and responds to requests for information or support in a timely manner.
• Attends regular agency and program staff meetings to disseminate information and provides support.
• Knowledgeable in documentation and service coordination standards.
• Other related duties as assigned.

Minimum Qualifications:

High School Diploma or GED with three (3) year experience in a technical job related to the area of assignment. May require a valid driver's license.

• Bachelor’s degree in counseling, social work, psychology, or closely related field AND 2 years of professional experience in a Behavioral Health/Addictive Disease/Intellectual Developmental Disabilities setting.
• Performs daily tasks with minimal supervision.
• Knowledge of DBHDD provider manual and guidelines.
• Proficient use of CareLogic or other Electronic Health Record systems.
• Proficient understanding of authorization processes.
• Proficient use of Microsoft applications (Excel, Power Point).
• Ability to multi-task and initiative to solve problems.
• Ability to work well in a team environment and independently.
• Experience working with Microsoft Excel Spreadsheets
• Excellent communication, time management, and attendance skills

Requirements/Competencies:

• Must be able to lift 20 pounds.
• Requires long periods of sitting/standing.
• Must have valid Georgia driver’s license and Motor Vehicle Record in accordance with company policy.
• Candidates for selection must pass a criminal background check (including fingerprinting).
• Must pass a pre-employment drug screen and subject to random drug screens.

Note: Some positions may require a valid driver's license.

Benefits (for qualified employees):

• State Health Benefits Package (medical, dental, vision, life insurance, disability, long-term care, legal services, flexible spending accounts).
• Company contributes 7.5% of salary to 401(a) Retirement Plan.
• Generous PTO – plus 9 holidays per year – and a paid Cultural/Spiritual/Service Day!
• No employee deduction for Social Security – means more money in your paycheck!
• Additional benefits such as legal services, Employee Assistance Program and discounted tickets to attractions, shopping, technology, and travel.
• Qualified employer for Public Service Loan Forgiveness (PSLF).
• Clinical supervision, training, and continuing education opportunities available.
• Flexible hours available, including telehealth from home!

View Point Health is an Equal Opportunity Employer: View Point Health recruits qualified candidates for positions in View Point Health programs throughout its service area. It is the policy of View Point Health to provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination or harassment of any type without regard to race, color, sex, religion, national origin, age, disability, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws