Utilization Review Assistant
Affiliated Computer Services, Inc. - Helena, MT

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Xerox Corporation is a $22 billion leading global enterprise for business process and document management. Through its broad portfolio of technology and services, Xerox provides the essential back-office support that clears the way for clients to focus on what they do best: their real business. Headquartered in Norwalk, Conn., Xerox provides leading-edge document technology, services, software and genuine Xerox supplies for graphic communication and office printing environments of any size. Through ACS, A Xerox Company, which Xerox acquired in February 2010, Xerox also offers extensive business process outsourcing and IT outsourcing services, including data processing, HR benefits management, finance support, and customer relationship management services for commercial and government organizations worldwide. The 130,000 people of Xerox serve clients in more than 160 countries.

If you meet the requirements of this position and want to work for a world-class company with a great marketplace reputation, apply today.

Provides support to the Coordinated Care Department including certification of services/procedures based upon national benchmarks.

ESSENTIAL DUTIES & RESPONSIBILITIES:
 Performs certifications based upon benchmarks listed in ICMS forwarding non-benchmark requests to clinical staff for review.

 Operates a variety of office-related equipment, such as multi-line phone system, computer, fax machine, copy machine, postage meter.

 Assists coordinated care staff with certifications by reviewing information submitted that does not need medical necessity certification/non-certification; collection and transfer of non-clinical data; acquisition of structured clinical data; and activities that do not require evaluation or interpretation of clinical information. Certifications of services that require clinical review are forwarded to licensed clinical staff per tasks in ICMS System.

 Performs a variety of general administrative duties for the Coordinated Care Department:

 Calls hospitals to obtain status of patients on Inpatient Log. If patient isn’t discharged, obtains current status and requests update accordingly. If patient has been discharged; date of discharge is verified and retro review is requested if entire length of stay has not been certified.

 Distributes voicemail messages from the Coordinated Care Department mailbox.

 Answers telephone calls to the Coordinated Care Department

 Facilitates electronically filing/scanning of medical records in the appropriate format and location

 Other duties and responsibilities as directed by supervisor.

 Regularly interacts with Third Party Administrators to exchange certification information.

 Adheres to URAC standards for programs which ACS is currently accredited.

 Participates in quality improvement strategies by assessing individual and employer satisfaction of programs. Identifies and addresses quality issues.

 Conducts research as appropriate, to obtain/maintain knowledge of cultural differences including socioeconomic factors, cultural traditions, and spiritual beliefs.

 Establishes and maintains effective working relationships with patients and their families, providers and payers.

 Assists in the implementation and adherence to policies, procedures, and new programs related to Utilization Management and Quality Improvement.

 Collaborates with other departments to promote coordination and communication within the Company regarding integration of administrative activities, quality improvement, and clinical operations.

 Assists other administrative staff, as needed. Seeks out other administrative staff that might need assistance when own work is up-to-date.

 Other duties and responsibilities as directed by supervisor.

EXPERIENCE/ABILITY REQUIRED:
 Minimum of one year experience in a Utilization Management or related setting.

 Proficiency in basic medical terminology.

 Proficiency in Microsoft Office products, such as Word, Excel, Access (others as identified by supervisor). Creates error-free documents.

 Effective communication skills—verbal, written, interpersonal, and phone, in order to interact with internal departments and external contacts.

 Accurate spelling, grammar, and documentation preparation skills.

 Ability to work with a wide range of personalities in a courteous, effective, and efficient manner, representing ACS in a professional manner.

 Ability to attend to numerous details under the stress of maintaining courteous, accurate and timely relations with a variety of individuals.

 Ability to establish and maintain effective working relationships with co-workers and department managers, and medial providers.

 Ability to work independently, with minimal supervision.

 Ability to apply common sense understanding in carrying out detailed written or oral instructions.

 Ability to comprehend the consequences of various problem situations and to refer such problems to the appropriate individual (or supervisor) for decision-making.

EDUCATION:
 High school diploma, general equivalency diploma (GED) or equivalent combination of education and experience.

 Completion of Medical Terminology course.

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ACS is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender/sex, marital status, sexual orientation, physical or mental disability, use of a guide dog or service animal, military/veteran status, citizenship status, or any other group protected by Federal or State law or local ordinance. People with disabilities who need a reasonable accommodation to apply or compete for employment with ACS may request such accommodation(s) by calling 866-419-2226 or by sending an e-mail to accommodations@acs-inc.com .

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About this company
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Affiliated Computer Services (ACS) handles jobs its clients would rather hand off. The company provides business process outsourcing (BPO)...