Case Management Specialist, Case Management, FT, 8:30A-5P
About The Position
This position is responsible for coordinating information between the Care Management Department and Third Party Payors (Insurance Companies). The role ensures timely submission of utilization reviews for the hospital to facilitate proper reimbursement from insurance companies and prevent denials. The Case Management Specialist acts as the department's liaison between insurance companies and the Care Manager, responding to insurance requests for clinical reviews/authorizations. This role maintains effective working relationships with insurance companies through ongoing communication and collaboration. The specialist works in conjunction with Access Management and Patient Financial Services to ensure accurate and timely submission of clinical reviews for appropriate reimbursement. Potential denials are directed to the Denials Coordinator, and assistance is provided with submitting missing documentation to insurance companies when necessary. The role also involves key business functions such as creating and maintaining staffing schedules, managing payroll, inventory management, purchasing, and invoicing. Effective communication skills are used to support the dissemination of information to staff. The specialist supports operational initiatives and projects by providing regular informational reports, analysis, and organizing data for utilization review management.
Requirements
- Associate of Arts - AA required.
- Administrative experience.
- Advance computer knowledge including Power Point, MS Office and Excel.
- Ability to operate office equipment and expand knowledge and learn new software.
- Excellent verbal and written communication and interpersonal skills.
- Skilled in multi-tasking, planning, critical and independent thinking.
- Able to achieve results through influencing.
- Able to maximize efficiencies while supporting fast pace work environment which may include multiple locations and leaders.
- Minimum of 4 years of experience.
- Experience with healthcare regulatory agencies preferred.
Nice To Haves
- Bachelors degree preferred and/or a combination of relative work experience preferred.
Responsibilities
- Coordinate information between the Care Management Department and Third Party Payors.
- Ensure timely submission of utilization reviews for the hospital to effect proper reimbursement and prevent denials.
- Serve as the department's liaison between insurance companies and the Care Manager for clinical reviews/authorizations.
- Maintain effective working relationships with insurance companies through communication and collaboration.
- Work with Access Management and Patient Financial Services to ensure accurate and timely submission of clinical reviews for reimbursement.
- Direct potential denials to the Denials Coordinator and assist with submitting missing documentation to insurance companies.
- Create and maintain staffing schedules.
- Manage payroll.
- Perform inventory management.
- Handle purchasing and invoicing.
- Provide support in disseminating information to staff using effective communication skills.
- Support operational initiatives and projects by providing informational reports and analysis.
- Organize data for utilization review management.
Benefits
- Career growth and development opportunities, with clear pathways and ongoing support
- Comprehensive health and wellness resources that go beyond traditional benefits
- A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs
- Tuition reimbursement to support continued learning and advancement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
