Career Center

JOB SUMMARY: Manages Requests for Outside Services. Applies Screening Criteria for Harris Health eligible patients. Secures authorization for third party payers by providing pertinent clinical documentation according to payer guidelines. Communicates with clinic staff regarding insurance denials and impending insurance authorization expirations. Facilitates peer to peer review between the clinical staff and the payer for denied cases. Enters authorization information into EPIC Telephone Encounters. Schedule patients for outsourced procedures. Follows up with test results and ensure placement in EPIC for physician retrieval. Strong written and verbal skills are necessary in order to communicate with clinical staff and payers.

MINIMUM QUALIFICATIONS:

Education/Specialized Training/Licensure: LVN in good standing, currently licensed in the State of Texas without stipulations in practice.

Work Experience (Years and Area): Minimum 3 years of hospital experience in various clinical areas. 1 year utilization review, authorization or case management experience necessary. Knowledgeable with hospital coding and billing processes preferred. Knowledge of Interqual/Milliman guidelines preferred. EPIC EMR experience preferred.

Management Experience (Years and Area): Preferred but not necessary.

Equipment Operated: PC functions, calculator, general office equipment.

SPECIAL REQUIREMENTS:

Communication Skills: Above Average Verbal (Heavy Public Contract), Exceptional Verbal (e.g., Public Speaking), Writing /Composing: Correspondence, Reports

Other Skills: Analytical, Mathematics, Medical Terms, P.C., Word

Work Schedule: Flexible

Other Requirements: Requires travel to HCHD facilities. Must be able to interact successfully in a culturally diverse environment.