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King's Daughters' Hospital is Hiring a Payer Communication Specialist Near Ashland, KY
King's Daughters Medical Center
Case Management
Ashland, KY
Full Time - Days
Clerical
Req #: 23120
Summary
JOB SUMMARY
Provides clerical and administrative support to the case management (CM) department to prevent and manage denials. Duties include researching and updating the payer requirements and follow up on pending authorizations and appeals.
DUTIES AND ESSENTIAL FUNCTIONS
Responsible for processing incoming mail related to utilization management process.
Communicates denial information to revenue integrity department.
Submits appeals for technical denials and supports the case manager in appeal cases.
Researches and confirms the payer requirements and educates the CM team on such requirements while keeping those requirements on the shared drive.
Maintains all payer portal.
Acts as a liaison for the business office for all claim issues as well as all payers and onsite nurses.
Calculates the Medicare Days for patients to ensure proper authorization is obtained when requested by the case manager.