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).
The salary range for this position is $22.18-$23.42/hour