Job Description

Performs a variety of clerical duties supporting daily Case Management activities and department clinical staff.

Job Responsibility

• * Maintains census board with patients' plan of care, coverage status, discharge plan, and related information
• * Generates, prints and distributes census reports from department computer system.
• * Processes requests for clinical reviews on all patients including patients with length-of-stay of two or more days
• * Sends patient clinical reviews and related documentation to managed care companies. Performs follow up on patient approval status.
• * Receives approvals from managed care companies, informs stakeholders and updates records accordingly.
• * Monitors discharges and intents and generates related reports, as required
• * Communicates with nursing homes and homecare agencies to facilitate patient discharge planning.
• * Assist clinical staff with administrative aspects of closing out cases
• * Participates in healthcare team huddles and rounds, as required.
• * Facilitates processing of retro clinical reviews:
  • Enters required information into department computer system.
  • Communicates with Medical Records to obtain required documentation.
  • Reviews status of retro clinical reviews and triages each case to next appropriate facilitator (i.e Appeals RN, Physician Advisor, etc.).
• * Facilitates processing of managed care denials:
  • Generates, prints and distributes denial documentation.
  • Enters required information into department computer system.
  • Communicates denial status to appropriate Case Manager.
  • Collects appeal documentation from clinical team members and distributes to appropriate managed care company Performs follow up on patient approval status
  • Receives, records and maintains documentation of appeal outcomes.
  • Closes out cases accordingly in department computer system
  • Collaborates with internal stakeholders on related special projects, as needed.
• * Performs receptionist duties including, but not limited to:
  • Greets, screens and directs visitors to department.
  • Schedules and arranges meetings, as requested.
  • Answers telephone, directs calls, and takes and relays messages.
  • Opens, logs and distributes department mail.
• Performs related duties as required.

*ADA Essential Functions

Job Qualification

• High School Diploma or equivalent, required. Business school graduate, preferred.
• Minimum of six (6) months related experience (case management, financial counseling, medical billing, insurance verification, and/or healthcare), required.
• Working knowledge of Microsoft applications, required.
• Knowledge of medical terminology, required.

*Additional Salary Detail
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).