At Monroe Hospital, our dedicated team of professionals is committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, a Top-15 hospital system in the United States, Monroe Hospital is actively seeking new members to join its award-winning team!

Monroe Hospital is a 32-bed community hospital located in beautiful Bloomington, Indiana. Monroe Hospital is committed to providing superior healthcare, ever mindful of each patient's individuality and unique needs. Monroe Hospital has been recognized by Healthgrades as a Patient Safety Excellence Award recipient, a distinction that places Monroe Hospital among the top 10% of all short-term acute care hospitals. For more information, please visit www.monroehospital.com.

We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. The Utilization review tech will further support the department needs for Release of Information, discharge coordination or other duties as assigned.

EDUCATION, EXPERIENCE, TRAINING

1. Minimum one year denials management experience in acute care setting highly preferred.

2. High School Diploma or equivalent required.

3. Accurate alphabetic, numeric, and/or terminal-digit filing skills.

4. Computer data entry with 10-key, with accurate typing speed of 35 wpm required. Excel skills highly preferred.

5. Knowledge of terminal digit filing and medical terminology; preferred.

6. Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.

7. Completion of a medical terminology course; preferred.

8. Background in business and office training; preferred.

#LI-AS2