Description: Under the direct supervision of the HIM manager, the UR specialist monitors the utilization of resources, risk management, and quality of care for patients by established guidelines and criteria for designated settings and status. Collection of clinical information necessary to initiate commercial payer authorization. Obtain and maintain appropriate documentation concerning services by reimbursement agency guidelines.
Education: Appropriate education level required by licensure.
Experience: Three years of relevant experience with superior communication and interpersonal skills. Minimum one-year healthcare or clinical experience required.
License Requirements: Licensed Practical Nurse (LPN) license with the State Nursing Board and/or possess multistate licensure privileges, or a Registered Health Information Technician (RHIT) required. Additional coding certifications are also acceptable such as certified coding specialist (CCS), certified coding specialist physician (CCS-P), certified professional coder (CPC), and certified professional coder–hospital (CPC-H).
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