About the position
The Care Management Assistant at Advocate Health is responsible for supporting the care management team by monitoring task reports, responding to requests from billing, insurance verification, and service offices. The role involves obtaining documentation for prior approval requests on patients with HFS insurance, tracking clinical updates, and ensuring timely submission of documentation to Enterprise Care Managers (ECM). The assistant will also verify authorized visits against actual visits and communicate with external case managers regarding visit summaries. Additionally, the position requires obtaining plans of treatment and supplemental orders to support prior authorization requests and monitoring contracted therapy vendors for over-utilization and unauthorized services.
Responsibilities
- Monitor Task Report and respond to requests from billing, insurance verification, and service office.
- Obtain documentation for Prior Approval Request on patients with HFS insurance.
- Contact Clinical Manager on any urgent issues or patients where documentation does not support projected number of visits.
- Track clinical updates for timely submission of written documentation to Enterprise Care Managers (ECM).
- Identify ECM through Active Advice.
- Submit appropriate documentation to ECM upon patient discharge from Home Health.
- Submit additional documentation upon request to ECM for AdvocateCare patient population.
- Verify authorized visits versus visits made and visit frequency on specified payers.
- Report final visit numbers to external case manager.
- Review and match actual visits to authorized visits at specified times (i.e. discharge and recertification) and communicate visit summary to external case manager.
- Notify internal Case Manager of any discrepancies.
- Obtain Plan of Treatment and/or Supplemental Orders to support request for Prior Approval on patients with HFS health plan.
- Track supplemental orders to obtain prior authorization from HFS on ALL therapies.
- Communicate authorized visits to contracted vendors on HFS patients.
- Monitor contracted therapy vendors for over-utilization and unauthorized services.
- Assist Case Managers with documentation process as needed.
Requirements
- High school diploma or equivalent.
- Experience in healthcare or a related field preferred.
- Strong communication skills.
- Ability to work collaboratively in a team environment.
- Detail-oriented with strong organizational skills.
Nice-to-haves
- Experience with insurance verification processes.
- Familiarity with home health care services.
- Knowledge of HFS health plans.
Benefits
- Paid Time Off programs.
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability.
- Flexible Spending Accounts for eligible health care and dependent care expenses.
- Family benefits such as adoption assistance and paid parental leave.
- Defined contribution retirement plans with employer match and other financial wellness programs.
- Educational Assistance Program.
