Utilization Analyst FT Temp (P)

• Coordinates and supervises data and reporting needs, data collection process and data processing issues and provides timely utilization data and analytic support.
• Frequent contacts with other organizational units and outside facilities staff to obtain, verify and/or provide information, e.g., works with Regional Claims and outside hospitals to reconcile billing charges.
• Answers inquiries and educate patients, physicians and hospitals on covered benefits and charges.
• Provides information and assistance to Health Plan members during claims review process and coordinates authorized and non-authorized claims review.
• Documents outside medical services and reinforce procedures for patients seen in outside emergency department.
• May coordinate and supervise Air & Ground Transportation and Prospective Review Authorization Program.
• Coordinates and supervises claims and referral information.
• Provides information regarding member admissions to outside facilities.
• Maintain the consistency and integrity of the non-KFH utilization bed track computerized data management system.
• May assist in scheduling patient appointments and coordinating patient care.

• N/A

• High School Diploma or General Education Development (GED) required.

• N/A

• Experience applying analytic techniques and computer skills to hospital data.
• Strong analytic and verbal skills.
• Expertise with tracking, spreadsheets and graphic computer systems operating on PC mainframes.
• Knowledge of health plan benefits.
• Understanding of medical center operations, complex health systems, with the ability to quickly grasp regional policies, contract interpretation of out-of-plan medical services.
• Must be able to work in a Labor/Management Partnership environment.

• Health Connect experience a plus.
• Associate of Arts or Bachelors degree preferred.

Notes:

• Must work every 3rd weekend
• This is a temporary position for approximately three (3) months.