Case Management Authorization Specialist

Emory•Atlanta, GA

About The Position

Overview Be inspired. Be valued. Belong. At Emory Healthcare At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs And more Description RESPONSIBILTIES: The Case Management Authorization Specialist (CMAS) Follows developed policies and procedures to obtain insurance eligibility and benefits by identifying correct insurance plan and determining coordination of benefits with minimal guidance. The CMA is responsible for informing the care team and financial counseling of any discrepancies identified related to coordination of benefits and/or coverage as it relates to ineligible coverage, non-covered services or out of network status. The CMAS is responsible for reconciliation of clinical days authorized versus patient actual days in order to secure reimbursement for provided care. The CMAS is responsible for communication with the payors for any pending or incomplete notifications/cases and holds the ultimate responsibility of resolving any incomplete authorizations, no greater than 7 days post notification. The CMAS is able to initiate and follow up on retroactive authorization requests as directed. The CMA assists with providing technical and clerical support, as directed, to the Case Management team in order to timely transition patients into post-acute services within the allotted amount of reimbursable hospital days, as determined by the clinical authorization obtained. The CMAS will collaborate with insurance case managers to initiate/request authorizations for post-acute care. The CMAS will have a general understanding of navigating out of network coverage for post acute services. The CMAS ensures regulatory requirements are met as it relates to the MOON and IMM.

Requirements

High school education diploma or equivalent.
At least two years of experience in a healthcare setting is required.

Nice To Haves

College degree preferred.
Two (2) years of insurance verification, authorization, or related work preferred.

Responsibilities

Follows developed policies and procedures to obtain insurance eligibility and benefits by identifying correct insurance plan and determining coordination of benefits with minimal guidance.
Informing the care team and financial counseling of any discrepancies identified related to coordination of benefits and/or coverage as it relates to ineligible coverage, non-covered services or out of network status.
Responsible for reconciliation of clinical days authorized versus patient actual days in order to secure reimbursement for provided care.
Responsible for communication with the payors for any pending or incomplete notifications/cases and holds the ultimate responsibility of resolving any incomplete authorizations, no greater than 7 days post notification.
Able to initiate and follow up on retroactive authorization requests as directed.
Assists with providing technical and clerical support, as directed, to the Case Management team in order to timely transition patients into post-acute services within the allotted amount of reimbursable hospital days, as determined by the clinical authorization obtained.
Collaborate with insurance case managers to initiate/request authorizations for post-acute care.
Ensures regulatory requirements are met as it relates to the MOON and IMM.