Clinical Reimbursement Administrative Assistant
About The Position
At Genesis Healthcare, we are dedicated to improving the lives we touch through the delivery of high-quality care and exceptional service. As a leading provider in the long-term care industry, we believe in fostering a collaborative, inclusive and supportive work environment where every team member is valued and empowered to make a difference. Whether you're an experienced professional or just starting your career, we offer opportunities for growth, development, and advancement in a range of roles. Join us in our mission to enhance the well-being of our patients and residents while making a meaningful impact in the communities we serve.
Requirements
- High school degree with college/business school coursework is required.
- Prior experience in utilization review, case management or discharge planning is required.
- Must be proficient in Microsoft office products.
- Strong organization skills are required.
Nice To Haves
- Experience with medical terminology is preferred.
Responsibilities
- Collaborate with the clinical team to obtain information necessary to ensure timely submission of concurrent reviews and subsequent authorizations for all managed care patients.
- Review Pre-Admission Review (PAR) and IRM Pre-Authorization assessment to identify costly treatments, supplies or services.
- Confer with the clinical team to negotiate appropriate continuation of length of stay or extension of services and appropriate Level of Care (what is covered/what is not covered) and associated rates.
- Obtain payor authorization for recommended treatments, procedures, supplies, equipment and medications and all exclusions.
- Communicate contract terms for patient's stay to the interdisciplinary team to include the level of care, length of service, utilization of services, inclusions and exclusions, revenue per day, network providers and rehabilitation treatments.
- Monitor patient cases throughout stay to ensure utilization of services are in accordance with plan of care and minimize financial risk to patient and center.
- Identify overuse of resources such as rehabilitation therapy, diagnostic studies, non- formulary medications and medical supplies.
- Alert the interdisciplinary team regarding the last covered day of service for patients/residents.
- Assist the interdisciplinary team with patient/resident discharge/transition by ensuring network providers are known and securing all appropriate authorizations.
- Manage relationships with third party payers ensuring timely responses.
Benefits
- Variable compensation plans
- Tuition, Travel, and Wireless Service Discounts
- Employee Assistance Program to support mental health
- Employee Foundation to financially assist through unforeseen hardships
- Health, Dental, Vision, Company-paid life insurance, 401K, Paid Time Off
- Free 24/7 virtual health care provided by licensed doctors for all Anthem medically-enrolled employees and their immediate family members
- On-Demand Pay Program that allows for instant access to a portion of the money you’ve already earned
- Pet Insurance
- Term and Whole Life Insurance
- Short-term Disability
- Hospital Indemnity
- Personal Accident
- Critical Illness
- Cancer Coverage
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
