Imagine a career at one of the nation's most advanced health networks.Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.SummaryResponsible for the compliant, accurate and timely delivery of Observation Notifications directly to patients and/or their families/representatives while hospitalized under Observation Status/Patient Class. Responsible for other payer-based forms, including but not limited to ADAR forms. Assists Utilization Management (UM) team by acting as a bridge between the patient/family/representative and the UM team, as well as the Interdisciplinary team for the purposes of communication related to health insurance communication, requirements and related information. Prioritizes coverage at largest hospital site. Works highly collaboratively with the IP Care Management team on-site. Also responsible for working collaboratively with UM teammates to perform administrative and operational functions within the UM Department. Provides support to UM teammates by ensuring appropriate communication with insurance payers as well as related documentation within payer-specified timeframes. Performs clerical duties including but not limited to: Notitication of Admission of hospitalizations, faxes, online payer databases, voicemail coverage, discharge notifications, determinations, etc in the UM department following established standards and practices, adhering to UM policies and standards. This position is fully on-site. Job DutiesProvides compliant, accurate and timely delivery of appropriate Observation Notification directly to patients/families/representatives while hospitalized under Observation Status/Patient Class. Delivers other payer-based forms as warranted. Documents all related information according to departmental policy and procedure. Prioritizes coverage at largest hospital site. Ensures smooth utilization management department functioning which includes answering phones, communicating effectively and professionally through emails, relaying messages, printing documents from various electronic applications, and running daily reports.Accurately processes and documents incoming and outgoing communication in all forms in the hospital EMR or payer-specific web-based systems. Communicates time-sensitive information to UM teammates. Escalates challenges to leadership as needed. Involves payer-based supervisory staff when warranted. Communicates and documents all conversations with internal and external key stakeholders according to departmental policy and procedure.Minimum QualificationsBachelor's Degree 3 years Billing, health insurance, physician practice, case management, healthcare-related field, or equivalent operations. Ability to complete data entry, communicate clearly & accurately both in written and verbal communication. Knowledge of electronic medical records (EMR) and medical terminology. Ability to interact effectively & professionally with all key stakeholders, members of the interdisciplinary team and with all Colleagues, as well as with all patients/families/representatives. Ability to take direction, offer useful insight into work processes & brainstorm when challenges arise. Strong ability to work collaboratively. Strong organizational skills. Demonstration of strong critical thinking and clear communication skill set, as well as ability to demonstrate flexibility, teamwork as well as a high level of autonomy. Demonstration of ability to multi-task, prioritize/reprioritize as the day's work changes, as well as to assist others when work tasks are completed, involve leadership when challenging situations arise, and conduct oneself in a professional manner at all times through all interactions. Preferred QualificationsBilingual in English and Spanish. Physical DemandsLift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.https://youtu.be/GD67a9hIXUYLehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.