To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values—integrity, patient-centered, respect, accountability, and compassion—must guide what we do, as individuals and professionals, every day.
Under the general direction of the Manager Utilization Management/Revenue recovery, the Utilization Review Specialist/RAC Liaison (URS/RL) performs a wide range of utilization review and management activities in an attempt to prevent insurer denials, enhance revenue, and to recover payment for services that have been denied. Responsible for the collection of denial and appeal data as well as other clinical documentation when necessary. The URS/RL works collaboratively with other members of the UM/RR department, health care team, Care Coordination, PFAS, HIM, Contracting and SBO towards process improvement to avoid denials.
(number of years and type required to perform the position duties): Current licensure in the State of Connecticut as Registered Nurse. Masters Degree preferred.
Strongly preferred a minimum of five years of relevant clinical experience in hospital acute care along with relevant experience in case management, care coordination, and/or utilization management in a hospital or insurance setting. Strongly preferred knowledge of finance and billing practices.
Excellent communication, negotiation and organizational skills. Adaptability to a wide variety of interpersonal encounters with the entire hospital team. Comprehensive understanding in use of medical record to extract data. Working knowledge of third party and prospective payment systems. Computer/PC literacy required. Proficient in Microsoft Office including Word, Excel, Access and PowerPoint. Will be trained in use of professionally recognized criteria, ICD-9-CM Coding, Diagnostic Related Grouping (DRG). Must be able to work collaboratively and independently. Must be flexible with responsibilities in order to meet departmental needs.