| Title: | Medical Utilization Coordinator |
|---|---|
| ID: | 2037 |
| Pafford EMS: | Ridgeland, MS |
| Division/Department: | Medical Utilization Department |
| State: | Mississippi |
Job Description
Job Title: Medical Utilization Coordinator
Reports To: Medical Utilization Officer
Department: Medical Utilization
FLSA Status: Non-Exempt
POSITION SUMMARY:
|
The fundamental responsibilities of the Medical Utilization Coordinator is to ensure timely and accurate claim processing inclusive of but not limited to verify payors, collecting appropriate and necessary paperwork, working with facilities to ensure timely collection of needed authorization documentation, and working with billing office to facilitate the completion and correction of outstanding documentation issues.
|
Essential Duties and Responsibilities:
- Pre-Billing inclusive of but not limited to Charts, Insurance Verification, and collection of needed documentation.
- Work with Medical Utilization Officer on repetitive patient accounts. This will include maintaining current PCS forms and documents needed for billing to obtain prior authorization.
- Daily review of fax/scanned medical necessity forms, and attachment of those forms to patient records in CAD.
- Work with field management staff to obtain patient assessments when needed.
- Communicate with customers in a professional manner.
- Interact with payers to secure timely payment information and/or pre-authorization.
- Verify payor coverage through resources available.
- Maintain knowledge of payor regulations including need for pre-authorizations.
- Represent the organization professionally and appropriately.
- Ability to work in and participate in a team environment
Non-Essential Duties and Responsibilities
- Perform other duties as assigned.
Physical Requirements- (Field Employees Only)
- N/A
Minimum Qualifications:
- Able to work independently.
- High level computer skills.
- Excellent interpersonal skills.
- Service oriented.
Education/Licensing/Certification:
- (Preferred) Have one (1) year EMS dispatch experience.
- (Preferred) Be a currently state certified EMT
- High school diploma or GED
- Current state driver’s license.
Other Knowledge and Skills:
- Maintains professional competence and demonstrates concern for the competence of other members of the EMS health care team.
- Maintain HIPAA Compliance.
- Strong ability to multi-task at a high pace environment.
- Ability to uphold standards of practice and education.
- Ability to adhere to standards of personal ethics, on and off duty, which reflect credit upon the profession.
- Does not use professional knowledge and skills in any enterprise detrimental to the Company or to the public well-being.
- Ability to respect and hold in confidence all information of a confidential nature obtained in the course of professional work unless required by law to divulge such information.
- Has good working knowledge of all company policies pertaining to this position.
- Good knowledge of common physical illnesses, obvious symptoms, and medical terminology.
NOTE: The above statements are intended to describe the general nature and level of work being performed by the person assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, skills, and physical demands required of personnel so classified.
