Mission Statement
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Why Join Michigan Medicine?
Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in . Michigan Medicine is comprised of over 30, employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world’s most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.
What Benefits can you Look Forward to?
- Excellent medical, dental and vision coverage effective on your very first day
- 2 : 1 Match on retirement savings
Responsibilities
Essential :
Data entry of clinical review information for online authorizations into multiple web sites for multiple payersMaintain accuracy of payer grid by notifying appropriate staff and Revenue Cycle of changes in fax numbers, etc.Obtain authorization for services from third party payers and notify RN Case Manager of issues with authorizationsEnter authorization numbers and approval days / dates into the appropriate software system for utilization management and electronic medical records.Fax clinical reviews to payers, maintain confirmations, document completely and accurately activities performedInteract with payers during phone conversations, provide discharge dates and patient status informationRespond to email from Billing Department with requests for authorization numbers or patient statusAnswer departmental phones / messages and distribute to RN Case Managers mindful of coverage assignments.Assist in obtaining authorization for inpatient and observation care by providing payers with clinical information via fax, autoroute, and web-based programs, for example, E-Referral, Navinet, PnoteDemonstrate ability to use multiple computer programs to research patient informationWillingly and consistently offer assistance to staff especially when patient census is highActively participate in learning new technologiesProvide notification to out of state insurers when requested by case managersOther duties as assignedDAILY WORK DUTIES
Insurance Alert Changes from software system for utilization management : notify RN CM if additional clinicals are requiredFor web-based programs, for example, P Notes for Blue Cross PPO and Traditional and E Referral for Blue Cross Network (BCN), input patient data, submit initial review with InterQual criteria subset ( work queue)Utilize Accuroute a software fax program effectivelyAuthorizations / Certifications – obtained by phone calls, faxes, payer contact screenCombining Admissions – documenting in MiChart, submit codes for billingTelephone notification of out of state insurers, providing ICD codes (clinical follows)Navinet – Online portal to start process for Aetna, Cigna, BC Complete, Amerihealth, Priority to obtain authorizations and check for updatesGeneral faxingDCPA – authorizations pended, discharge information requiredList in MiChart to complete input of auths / certsFollow up on emails from professional billers by editing patient information in the utilization management software.Distribution of cases on the unassigned worklistRequired Qualifications
High School Diploma or GED.An Associate's degree in social sciences or other related field or an equivalent combination of education and experience is necessaryMinimum 3 years of experience.Analytical skills are necessary in order to assess urgency and complexity of workflowProficiency in medical terminologyProficiency in use of computer technology and experience with Microsoft Office software applicationsStrong interpersonal communication skills, including problem solving and decision makingDemonstrated telephone communication skills requiredExperience in a health care environmentAbility to work well with physicians and other health care providersStrong customer service and ability to work in a team environmentDesired Qualifications
Knowledge of UR processes and different levels of care within a hospitalKnowledge of the University of Michigan Hospitals and Health Systems computer software systemsKnowledge of the University of Michigan Hospitals and Health Systems Policies and ProceduresWork Schedule
Work schedule varies. Monday through Friday with some weekend and holiday coverage. Hours are 9 : 00am to 5 : 30pm
Modes of Work
Positions that are eligible for hybrid or mobile / remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the
