Our mission of providing care to the world at a moment's notice is at the heart of everything we do. We are caregivers, first and foremost and we will be there when you need us. With more than 38,000 employees, Global Medical Response teams deliver compassionate, quality medical care, primarily in the areas of emergency and patient relocation services around the world. We provide end-to-end medical transportation as well as fire services, integrated healthcare solutions and disaster response.
The Resource Utilization Support Specialist is responsible for providing the Senior Director and the Registered Nurses of the Resource Utilization Department necessary data entry, third party payer interfaces and all necessary organizational needs.
• Performs the monthly follow ups required for all appeals filed and physician letter/medical record requests in conjunction with the Patient Accounts Appeal Department.
• Completes all the physician letter requests and the medical record requests for the Resource Utilization Department.
• Completes all required appeal documentation within the Sweet billing system – Schedule changes, Collection Notes and documentation as required in Statistics.
• Reviews all appeals received from Patient Accounts for accuracy and need for appeal.
• Updates the Appeal database for all information, communication and processes as related to appeals.
• Assists in assuring the timeliness of each RN’s appeal database.
• Reviews and enters into the Appeals database the Medical Necessity Appeal files received from the Patient Accounts Appeal Department.
• Completes all written reports/memorandums and other duties as assigned by the Senior Director.
• Prepares the Utilization Review Quarterly, Bi-Annual and Annual reports for the Corporate QM Committee.
• Completes the monthly Utilization Review database entry.
• Completes each monthly Department budget review/spreadsheet and sends all variance information to the Senior Director.
• Responsible for maintaining and the ordering of all Department office supplies.
• Participates in and keeps meeting minutes for all Departmental meetings and any inter-departmental meetings as requested.
• Assists with the Sweet import process as directed.
• Completes the monthly Appeals Spreadsheet for internal reporting purposes.
• Performs all the filing, copying, faxing and mailing of the medical necessity appeals.
• Processes all third party payer inquiries as requested by the Department RNs.
• Perform other duties as assigned.
WORKING CONDITIONS AND PHYSICAL REQUIREMENTS
GUIDING VALUES AND BEHAVIORS
Employee must consistently exhibit our guiding principles:
• Patient Care - We continually earn the privilege to care for our patients. It is at the forefront of everything we do.
• One Team - We respect each other and achieve together what no individual can alone.
• Innovation - We are driven to develop solutions that inspire progress.
• Vigilance - We will never waver in our commitment to safety and preparedness in the fulfillment of our duties.
• Ownership - We are accountable for what we do and take pride in how we do it.
• Citizenship - We are dedicated to being good stewards in the communities we serve.
Global Medical Response and its family of companies are an Equal Opportunity Employer including Veterans and Disabled