Support Specialist- Utilization Review/Remote
🔍 Troy, Michigan
The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution process. Responsible for obtaining and tracking approvals, denials, and additional information requests received from third party payers within the EMR.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
• Acts as a subject matter expert in insurance authorization requirements, time frames, and various revenue cycle related requirements.
• Submits all clinical information required by payers.
• Responds to payer requests, inquiries, and/or escalates issues to leadership.
• Processes, familiarizes, and completes communication forms required by payers.
• Works directly with coordinators regarding clinical issues for resolution.
• Processes all incoming communication from payers via fax, voicemail, email and mail, appropriately routes information to assigned team members.
• Update and load case information to payers as needed.
• Maintain a current knowledge of Utilization Management through interaction with staff and payor portal representatives.
• Identify process improvement strategies.
• Promotes individual professional growth and development by meeting requirements for mandatory continuing education and supports department goals which contribute to success of the organization.
• Perform other duties as requested
EDUCATION AND EXPERIENCE:
- High School Diploma/G.E.D.
- Working knowledge of computers and software systems
- Communication skills, verbal and written, and interpersonal skills necessary to effectively achieve department outcomes.
- Minimum one (1) year of experience in healthcare.
- Experience working in Epic preferred.
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers.
Benefits
The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.