Utilization Management – Precertification Specialist

Responsibilities Utilization Management - Precertification Specialist HAVENWYCK HOSPITAL (a UHS facility) Havenwyck Hospital s a Joint Commission-accredited and licensed psychiatric hospital, overlooking Lake Galloway in Auburn Hills, Michigan.

We specialize in providing comprehensive, compassionate behavioral health services to children, adolescents and adults. It is the ultimate goal of our dedicated staff to build strength, confidence and knowledge within each patient, in hopes that they may continue learning and understanding their needs and practicing self-care for the rest of their lives.

For more information, please visit us at POSITION SUMMARY : The Utilization Management Precertification Specialist has responsibility for obtaining prior authorizations for Inpatient and Partial Hospital Program services by successfully completing the authorization process with all commercial payers.

The position will provide daily coverage to complete admission and step-down precertifications, track Medicare certifications, and submit discharges to various payers.

These duties shall be directed toward supporting the hospital's mission in the pursuit of excellence in care / service and will include (but is not limited to) : conducting timely admission and step-down precertification with external payers, obtaining Medicare Certifications from Physicians, and submitting discharges to various payers.

Report initial authorizations, denials, and documentation concerns, as well as collaborate effectively across departments to minimize denials / faciliate optimal use of hospital resources.

Duties will include : Through clinical skills, reports to external insurance and review entities an accurate presentation of the presenting symptoms / medical management of a patient’s illness.

Research patient benefits and payer precertification requirements and obtains initial authorizations via payer website, fax, or by phone, as well as follows up regularly on pending cases.

Relays clinical data in a professional, assertive, clear, and organized manner. Gathers patient discharge information from all units daily.

Double checks accuracy of aftercare appointment address and phone number. Enters patient discharge data in various payer systems in a timely manner and updates MIDAS as needed.

Faxes / mails discharge packets. Maintains a positive rapport with managed care providers; acts as a representative of Havenwyck Hospital.

Runs Medicare Compliance Reports, tracks and records completion of Medicare Certificates, as well as Admission and Discharge Important Message from Medicare, uploads Medicare Certificates and updates MIDAS certification and Medicare Screens appropriately.

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