What are the responsibilities and job description for the Assistant-Case Management position at North Mississippi Health Services?
Recordkeeping/Documentation/Reporting
- Manage the reconsideration and clinical appeals processing of documents from IQH, HMS, and other 3rd party payers
- Documents and notifies insurance companies/3rd party payors of patient hospitalization to NMMC-Acute Care setting
- Coordinates the retrieval and submission of patient medical information for maximum reimbursement
- Records and communicates payor requests and authorizations
- Retrieves requested medical information and submits to insurance company/3rd party payor for post-acute care coordination (i.e. UM Reviews including clinicals, Discharge Plan)
- Maintains electronic Blue Cross/Blue Shield of Mississippi Census and other electronic census that may arise
- Generates and provides chart audit reports to appropriate personnel
- Reconciles discharge dispositions and other regulatory requirements as assigned
- Manages, documents, and tracks Medicaid TAN requests
- Electronic submission of Medicaid reviews for certification as required Clerical :
- Answers telephone calls, takes messages and responds to emails in a polite, professional manner Communication:
- Communicates effectively with staff, patients, family members, vendors and Management Customer Service:
- Provides accurate information and direction for patients, visitors, and staff; has a knowledge of hospital functions and resources
- Supports staff as needed Education:
- Maintain annual review requirements Regulatory Compliance :
- Adheres to NMHS/NMMC Policies/Procedures/Guidelines
- Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues Requirements:
- High School Diploma or equivalent; required/Associates Degree in Business Administration, Office System Technology or related field; preferred
- Minimum of 1 year administrative, managerial, supervisory, clerical, or office experience; required
- Excellent organizational and communication (written and verbal) skills; required
- Working knowledge of wireless paging systems, computer systems and programs; required
- Excellent telephone etiquette; required
- Excellent knowledge of medical terminology; required
- Effective interpersonal skills; required