JOB SUMMARY: Manages Requests for Outside Services. Applies Screening Criteria for Harris Health eligible patients. Secures authorization for third party payers by providing pertinent clinical documentation according to payer guidelines. Communicates with clinic staff regarding insurance denials and impending insurance authorization expirations. Facilitates peer to peer review between the clinical staff and the payer for denied cases. Enters authorization information into EPIC Telephone Encounters. Schedule patients for outsourced procedures. Follows up with test results and ensure placement in EPIC for physician retrieval. Strong written and verbal skills are necessary in order to communicate with clinical staff and payers.
Education/Specialized Training/Licensure: LVN in good standing, currently licensed in the State of Texas without stipulations in practice.
Work Experience (Years and Area): Minimum 3 years of hospital experience in various clinical areas. 1 year utilization review, authorization or case management experience necessary. Knowledgeable with hospital coding and billing processes preferred. Knowledge of Interqual/Milliman guidelines preferred. EPIC EMR experience preferred.
Management Experience (Years and Area): Preferred but not necessary.
Equipment Operated: PC functions, calculator, general office equipment.
Communication Skills: Above Average Verbal (Heavy Public Contract), Exceptional Verbal (e.g., Public Speaking), Writing /Composing: Correspondence, Reports
Other Skills: Analytical, Mathematics, Medical Terms, P.C., Word
Work Schedule: Flexible
Other Requirements: Requires travel to HCHD facilities. Must be able to interact successfully in a culturally diverse environment.
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.