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Tufts Medicine Admin Coordinator, CDI and Utilization Review Management in Burlington, Massachusetts

This position is responsible for financial management projects in the Utilization Management/CDI Departments. The Utilization Management/CDI Administrative Coordinator ensures continuous, efficient and smooth flow of administrative support activities for the Utilization Management Department/CDI departments. The position accomplishes these tasks, in part, by assisting callers, taking messages, tasking Utilization Managers and CDI’s, managing the department’s calendar, placing purchasing orders, maintaining an up- to-date online filing system, running reports from various systems and maintaining schedules. The Administrative Coordinator interfaces with all payers, obtains and records authorizations, manages all requested UM clinical documentation, tasking UM nurses when appropriate. Working closely with the Finance Department, the incumbent connects the work of the Utilization Management/CDI Departments with the Finance Department. This is essential to ensure and contribute to the capture of the Health Systems revenue. Performs standard and advanced administrative duties for the departments. Provides administrative support to the CDI Director and to the Utilization Director as needed.

Responsibilities

  • Responsible for managing daily interaction with all the insurance companies, including receiving all the daily communications from the Insurance Companies, responding to their requests by sending utilization manager clinical reviews and discharge summaries, and tasking the remainder of requests to the utilization managers as appropriate.

  • Enters clinical requests and continued stay requests into the EMR as they arrive via fax, phone or hospital reports and tasks the correct utilization manager accordingly.

  • Reviews discharge list and identifies accounts that have discharged prior to UM review and tasks those accounts to the appropriate UM nurse.

  • Gains and maintains access to applicable payer websites.

  • Keeps up to date insurance company contacts, fax numbers, clinical requirements, and criteria tool.

  • Notifies insurance companies of patient discharge date and disposition per each payer requirement and assures completed authorizations are obtained and documented in the EMR.

  • Attends weekly High Dollar meetings with finance to ensure authorizations are obtained on all high dollar cases.

  • Works on daily missing authorizations, ensuring the authorizations are captured for medical necessity by interacting with multiple individuals and multiple departments, thereby, enhancing the speed of cash flow. Responsible for the forwarding of clinical information obtained from the case managers or retrieving it from insurers, and directing to appropriate payer in order to obtain authorizations

  • Notifies the Finance and Admissions Department of any changes to inpatient accounts, such as level of care, appeal outcome, re-bills, bridges and billing charges to improve cash flow.

  • Assists the Director\ with the department’s payroll using Kronos

  • In collaboration with Director, maintains accurate statistics for specialty areas and distributes to appropriate designees. Prepares reports, statistics, and any other reports as requested by Director(s) and for assigned areas.

  • Runs reports and analytics for Clinical Documentation Integrity

  • Supports the Director of Clinical Documentation Integrity with special projects

  • Tracks data monthly and reports to Director.

  • Coordinates the assignment and set up of new staff, processing network request forms, passwords and ordering and setup of new equipment, i.e. computers, phones and email.

  • Assists with developing coverage plans and arranging staffing. Calls per diem staff when needed to fill schedule holes.

  • Processes hospital forms including, but not limited to: employee action form, purchase requisition, request for payment, Ensures that appropriate documentation is attached to each form.

  • Attends meetings, as requested, and prepares meeting notes for distribution.

  • Types correspondence, reports, memoranda, staff meeting minutes, special projects, and related material for department staff as requested by Directors.

  • Maintains established departmental policies and procedures, objectives, quality assurance program, safety, environmental and infection control standards.

  • Maintains office files through development of an organized and efficient filing system. Ensures that filing is maintained on a daily basis. Filing will also include maintaining a directory on the hospital network to minimize the need for paper filing.

  • Receives, handles, and transfers phone calls and messages within the department promptly and courteously. Forwards all appropriate emails to staff as requested by vendors.

  • Responsible for answering phones in a professional manner and required for screening, referring, follow up calls, and taking messages and managing voice mail.

  • Provide departmental administrative and clerical support and participates in special projects as needed.

  • Maintains confidentiality in all office manners

    Experience

  • Bachelor’s degree or Associate’s degree and equivalent years of experience

  • 3-5 years’ experience in a hospital setting preferably Utilization Management

  • Competence in Excel, Access, Word, PowerPoint

  • Kronos, Lawson, Tiger text

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