Administrative Assistant II - Appeals Management- Ave North

Christiana Care Health Services•Wilmington, DE

4d•Onsite

About The Position

ChristianaCare is seeking a full-time Administrative Assistant II to join their Utilization Management department, specifically supporting the Denials and Appeals team in Wilmington, DE. This role involves working closely with the RN Appeals Management Nurse and Physician Advisors to optimize appeals for denied Inpatient hospitalizations. Key duties include scheduling, data entry, form completion, mailing, creating appeals packets, contacting insurance companies, and collaborating with other revenue cycle departments. Prior claims knowledge is essential. The ideal candidate will be well-organized, detail-oriented, capable of multitasking, and able to complete tasks within prescribed timelines. Strong computer skills and excellent verbal and written communication skills are required.

Requirements

Prior claims knowledge is essential.
Well organized, detail oriented and can multitask.
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.