Time Type:
Full time
Hours per Pay Period:
80
Shift:
Varied
Average rate:
$53.43 USD(This represents the rate for an individual with significant experience in this job)

Department:
Patient Access - Radiology/Scheduling/Ins

Current Bay Area Hospital Employee: If you are a current Bay Area Hospital employee, please apply through the Workday internal career site.

The future looks bright at Bay Area Hospital, and we are always searching for quality people to join our team. We offer a great atmosphere, competitive pay, a wide array of benefits, and many growth opportunities for our employees.

Job Description:
Financial Clearance Utilization Review Analyst

Performs pre-service/pre-payment review analysis to assess and evaluate the efficiency and appropriateness of services for medical necessity through interpretation and review with evidenced-based criteria, clinical guidelines/medical policies, corporate guidelines and policies, mandates and standards. Assist with the scheduling of tests and procedures including but not limited to surgery, radiology complex tests/procedures and other outpatient services as needed. Ability to comprehend policies, patient records, physician orders, procedures and guidelines. Performs pre-admit registrations; obtain/document patient insurance and demographics.

SKILLS AND ABILITIES

• Demonstrates a high level of mental and emotional tolerance sensitivity, diplomacy, sound judgment, and a professional attitude when relating with patients, families and co-workers.
• Performs duties with frequent interruptions, in close quarters and under time constraints in a professional manner.
• Has knowledge of medical and technical terms used within the hospital. Maintains a current knowledge of the legal aspects of nursing and of the policies, procedures and regulations of the hospital. Clearly understands purposes, objectives, practices and procedures of department.
• Seeks creative alternatives and innovative possibilities in problem solving. Demonstrates a strong ability to identify, analyze and solve problems and can be a relied upon to make sound decisions. Understands and considers the impact decisions may have on other departments.
• Is consistent, dependable and accurate in carrying out responsibilities to a successful conclusion. Is reliable to meet schedules and deadlines consistently.

• Maintains regular, consistent and punctual attendance at the assigned job location
• Proficient knowledge of ICD-10, CPT-4 Coding and HCPCS Coding. Certification preferred.
• Demonstrates the ability to operate applicable office equipment and types over 25 words per minute.
• Exhibits the ability to communicate effectively with internal and external stakeholders.
• Exhibits the ability to maintain confidentiality and perform day-to-day tasks independently with minimal supervision.
• Proficiency in navigating and utilizing web browsers, payer web sites, Microsoft Outlook, Word, Excel, other software applicable to position including the ability to navigate multiple systems and keyboarding.
• Proficiency in performance of basic math functions, capability of communicating professionally and effectively in English, both verbally and in writing.
• Demonstrates working knowledge of health insurance types, eligibility, and benefits.
• Demonstrates a time conscious awareness and ability to prioritize. Distinguishes between low and high priority activities and is exhibits flexibility by being available for all partners and team.
• Ability to build collaborative relationships.
• Attention to details.
• Ability to interpret complex documentation.
• Ability to work independently.

EDUCATION/CERTIFICATIONS/LICENSES/DEGREES

• Licensed to practice as a Registered Nurse in the state of Oregon

EXPERIENCE

• One (1) year of clinical practice nursing experience in at least one of the following areas: medical-surgical nursing, surgical nursing, intensive care or critical care nursing preferred
• One (1) year of utilization review experience, with maintaining production standards and consistently performing with an error rate of 5% or less preferred
• Utilization management and/or medical review
• Previous experience obtaining healthcare authorizations and/or referrals preferred

GENERAL INFORMATION

Union Affiliation: ONA

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities and job skills required.

Physical/Mental/Environmental Requirements

• Requires extensive sitting with periodic standing and walking
• May be required to lift up to 20 pounds
• Requires significant use of personal computer, phone and general office equipment
• Needs adequate visual acuity, ability to grasp and handle objects
• Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone
• May require off-site travel

Compensation Grade:
ONA

Compensation Grade Profile:

Bay Area Hospital is an Equal Opportunity Employer.

Anti-Retaliation Notice