The Utilization Review Coordinator requires a coordinated effort involving physicians, nursing and the entire interdisciplinary team, including patients and family members. Responsible for authorization of appropriate services for admission, continued stay and discharge.
DUTIES AND RESPONSIBILITIES:
Consults with physicians and therapists for clarification of clinical data when necessary to ensure maximum charge capture, billing and collections for the level of care that is medically necessary.
Performs Utilization Review assessments on patients admitted for outpatient behavioral health services.
Acts as advocate for patients to receive medically necessary behavioral health services, as determined by interdisciplinary team.
Possesses advanced knowledge of Medicare and Medicaid and other third-party reimbursement methodology, procedures, coding and requirements. Possess understanding of healthcare regulations and financial impacts and educate interdisciplinary team members, including patients and family.
Coordinates patient transition within levels of care within Benefis Behavioral Health Services.
Coordinates patient transition between designated facilities and community care; acting as a liaison between the physician, facility, and the community agency.
Educates patients, families, physicians and hospital staff about community care services and eligibility criteria.
Assist with discharge planning and implementation of discharge plan as determined by behavioral health team.
Attend team staffing.
Perform chart review to ensure appropriate documentation to obtain authorization for admission and/or continue stay in programming.
Completes documentation necessary for third party reimbursement.
Perform other job-related duties and assigned tasks as requested.
Maintains and keeps current reimbursement documentation in collaboration with the business office.
Adheres to dress code.
Completes annual educational requirements.
Maintains regulatory requirements.
Wears identification while on duty.
Maintains confidentiality at all times.
Attends department staff meetings as required within the department.
Reports to work on time and as scheduled; completes work in designated time.
Represents the organization in a positive and professional manner.
Actively participates in performance improvement and continuous quality improvement (CQI) activities.
Coordinates efforts in meeting regulatory compliance, federal, state and local regulations and standards
Communicates and complies with the Benefis Health System Mission, Vision and Values as well as the focus statement of the department.
Complies with Benefis Health System Organization Policies and Procedures.
Complies with Health and Safety Standards and Guidelines.
As a not-for-profit community health system, Benefis is driven to provide the highest level of care. We serve nearly 230,000 residents across a 15-county region that is bigger than Connecticut, Massachusetts, New Hampshire and Vermont combined. Benefis is the largest non-governmental employer in the Great Falls area, with more than 3,000 employees.Benefis has 530 licensed beds (that includes 146 beds in long-term care, 71 in assisted living and 20 beds at Peace Hospice of Montana) and partners with over 250 area physicians.Our hospital has been recognized for its exceptional work in quality care by providing a wide range of programs and services to help you live the best life possible. We’re here to help you “Live well.”Benefis Health System came about when two Christian-based hospitals became one. Our founders believed in providing good care to all in need, and trusted that this would be accomplished. The Benefis name was derived using Latin root words: "Bene-" meaning good, and "fis-" for faith and trust. It’s these same root words that make up such terms as ‘beneficial’ and ‘confidence’.Benefis has been a trusted provider of care for more than 125 years. And our name speaks to o...ur commitment: good care one can put faith in.Benefis is consistently ranked among America’s top hospitals by the nation’s leading healthcare ratings organizations for a range of services, including cancer care, joint replacement, stroke treatment, wound care and home health.To learn more about our services, continue looking through our website at WWW.BENEFIS.ORG or call 406.455.5000.