Provides support services to ensure precertification, authorization, and payment for inpatient servicesCoordinates the acquisition of equipment between the insurance company, vendor, health care teamsReviews patient medical records as assigned to provide clinical information to insurance payor for services and to obtain authorization for continued inpatient hospitalizationReconciles and maintains task lists to assign utilization reviews

The Utilization Manager is responsible for ensuring that patient care is managed efficiently, and costs are controlled by overseeing the utilization of healthcare services. This role involves verifying insurance coverage, coordinating with healthcare providers, and ensuring compliance with hospital policies and regulatory requirements. The Utilization Manager works collaboratively with clinical staff, case managers, and insurance companies to ensure appropriate care delivery and reimbursement.

• Receive and screen referrals by communicating with referral source, patient, and insurance companies in order to pursue referral information not available on initial contact•Provide an estimated cost of treatment based upon treatment plan, working with patient to establish payment arrangements and collect appropriate co-payments•Provides education for patients regarding billing processes and their financial responsibilities, facilitating resolution of patient’s financial questions and concerns•Schedule appointments for new visitors, tracking them from medical clearance through financial clearance

Ranked as one of "America's Best Hospitals" with over 5,000 employees, 1250 licensed beds, and 52 operating rooms; Scheduled and registered 150-200 patients per week, cultivating rapport and smooth communication with each patientScheduled patients for same day and future MRI, CT scans, and surgical procedures for The Methodist Hospital Physician's OrganizationPrepared, reconciled, and received payments for Admission, Outpatient, and Departure schedules with outpatient surgery nurses for upcoming proceduresOwned scheduling, billing, and precertification responsibilities for multi-million dollar healthcare organizationPlayed a key role in raising patient satisfaction scores from 84.1 to 94.2 by implementing I-CARE Values workshopOptimized production levels by 65% through implementation of Patient Access Incentive ProgramEliminated losses of 2.5 million dollars annually by spearheading the implementation of The Methodist Experience in Patient Access ServicesComputer/Client Software ApplicationsMicrosoft AccessMicrosoft OutlookMicrosoft WordMicrosoft ExcelMicrosoft Power PointPHSProxsysHospital Information Systems (HIS)Pathways Compliance Advisor 15.0