Case Management Support Specialist - Case Management

Health First Careers•Melbourne, FL

2d•Onsite

About The Position

The Case Management Support Specialist supports the Case Management department by ensuring appropriate communication and documentation with third-party payers to obtain authorization for hospital stays. The role also assists with discharge planning, reimbursement, and regulatory requirements, and flexibly fulfills a variety of departmental responsibilities. The position is full-time and onsite at Holmes Regional Medical Center, with four 10-hour day shifts. The specialist gathers and validates demographic and insurance information; supports referrals and discharge-plan execution; sends clinical information and required documents to payers, post-acute providers, and regulatory agencies; follows up with patients, families, and community agencies; documents authorization and denial information; and communicates service delays. The role requires professionalism, sound organization, communication and problem-solving skills, and maintaining confidentiality of protected health information.

Requirements

High school diploma or equivalent.
AHA BLS certification if the position is hospital-based; certification is not required for remote positions.
Previous customer service experience in a face-to-face environment.
Proficiency in Microsoft Office, including Outlook, Word, and Excel.
Ability to work autonomously with minimal supervision.
Strong critical-thinking skills.
Strong verbal and written communication skills and a professional presence.
Ability to maintain composure in a stressful office environment.
Ability to work flexible hours and days, including weekends, to meet departmental needs.
Ability to work directly with patients and families in patient care areas and by telephone.

Nice To Haves

Associate degree.
Medical, acute care, insurance, or social work experience.
One year of face-to-face customer service experience.
Strong organizational skills.

Responsibilities

Gather information from social workers, utilization review nurses, case managers, or patients to help validate demographic and insurance information and facilitate case management tasks relating to reimbursement, discharge planning, and regulatory requirements.
Follow appropriate infection control practices when meeting with patients and families in patient care areas to coordinate discharge-plan details.
Assist with referrals, including sending documents, making calls, and preparing letters for community providers and regulatory agencies.
Receive requests and send clinical information to third-party payers, post-acute agencies or services, and regulatory agencies as assigned for referrals, post-acute care, and reimbursement.
Complete delegated paperwork needed to execute discharge plans and deliver regulatory forms.
Follow up, as delegated, with patients, families, third-party payers, and community agencies to determine needs and provide information that facilitates discharge, reimbursement, or authorization of stays; document follow-up.
Use appropriate communication methods to relay information and ensure timely receipt and transfer of voicemail messages.
Maintain positive working relationships with patients, families, and people at all levels of the organization.
Document payer authorization and denial information and communicate clearly and accurately on accounts to support timely, accurate billing.
Recognize and communicate service delays to the Case Manager, Social Worker, and/or Utilization Review Nurse.
Use department policies, procedures, and organizational initiatives to complete assignments while maintaining the confidentiality of protected health information.