Administrative Assistant II - Appeals Management- Ave North

ChristianaCare•Wilmington, DE

5d•$22 - $33•Onsite

About The Position

Our Utilization Management department located in Wilmington, DE is looking for a full-time Administrative Assistant II to support the Utilization Management Denials and Appeals team. Work closely with RN Appeals Management Nurse and Physician Advisors to optimize appeals for denied Inpatient hospitalizations via administrative assistant supporting including but not limited to, scheduling, data entry, form completion, mailing, creating appeals packet, contacting insurance companies and working closely with other departments in revenue cycle. Prior claims knowledge is essential. The ideal candidate will be well organized, detail oriented and can multitask. Candidate to complete tasks and duties within a prescribed timeline. Strong computer skills as well as good verbal and written communication skills.

Requirements

Prior claims knowledge is essential.
Well organized, detail oriented and can multitask.
Candidate to complete tasks and duties within a prescribed timeline.
Strong computer skills
Good verbal and written communication skills.
Proficient with Microsoft Word, Excel, and PowerPoint
Proficient computer skills.
Ability to function as a member of an interdisciplinary team.
Ability to learn and understand basic medical terminology.
Ability to organize and prioritize work assignments.
Understand HIPPA/Privacy regulations with patient medical records
Knowledge of PC including EMR applications including power chart.
Typing skills are mandatory.
Strong organization and superior communication skills are required.
Knowledge of telephone communication skills.
High School diploma or equivalent required
Four years progressively responsible administrative support to an administrator or manager

Nice To Haves

Experience in a support role in Hospital Billing, Revenue Integrity, Utilization Management preferred
Knowledge of the insurance authorization process is preferred.

Responsibilities

Scheduling phone calls and meetings for members of the appeals team with payer representatives
Establishes collaborative relationships with Physician Advisors/ Admitting/Utilization Managers/Clinical Documentation Improvement Specialist / Care Managers/ Billing and other health care staff to effectively and efficiently complete appeals.
Enters accurate data, authorization/referral entries into computer system timely
Calls insurance companies for authorization, benefit verification, denial and appeals information, as requested.
Provides superior customer service to providers and members.
Acquires new skills needed for performing job functions as the healthcare/delivery system changes.
Participates as an active member of the team, offering suggestions and recommendations for more effective and efficient operations.
Assists in contacting patient and families to discuss appeal options, status, and outcome, as requested
Demonstrate ability to identify and define issues of concern, collect, and analyze data, establish facts, draw valid conclusions, and exercise discretion and sound judgment.
Maintains confidentiality of patient information.
Participates in seminars/workshops and in-service education regarding new resources, as requested.
Provides administrative support to the team; assists with copying, faxing, form completion, addressing emails and Medicare letters by department standards.
Assists with completion of Utilization Management duties including providing clinical information to insurance companies to obtain authorizations and updating patient records timely.
Assist in scheduling phone calls and meetings for members of the UM team with payer representatives.
Take lead on contacting insurance companies pending payor determinations for appeals.
Take lead on contacting insurance companies to resolve administrative denials in real time when possible, to avoid written appeals.
Establish a knowledge base for medical necessity requirements for all major insurance companies for inpatient authorization approval.
Establish a knowledge base for administrative requirements for all major insurance companies for inpatient authorization approval.
Assists with general support services and office coverage as staffing needs dictate.
Establishes collaborative relationships with Utilization Managers, Care Managers and other health care staff to effectively and efficiently complete necessary services.
Enters accurate data, authorization/referral entries into computer system as directed by team in an accurate and timely manner.
Calls insurance companies for authorization, benefit verification and coverage information as necessary.
Execute proper use of the telephone and voice mail systems.
Incorporates services standards for telephone contact into daily activities
Communicates effectively with departments in the Christiana Care Health System.
Performs specific projects as directed by Supervisor and/or Director.
Acquires new skills needed for performing job functions as the healthcare/delivery system changes.
Participates as an active member of the team, offering suggestions and recommendations for more effective and efficient operations.
Maintains confidentiality of patient information.