UM Case Manager

Swope Health•Kansas City, MO

About The Position

As a UM Case Coordinator for Swope Health's Services Behavioral Health Outpatient department, you will be apart of a team of caregivers to provide care for the people who need it the most. The UM Case Manager will provide assistance to individuals in effective use of benefits and application for eligible benefits, access to services, and assessment for potential services needed.

Requirements

Working knowledge of various insurances and their plans.
Familiarity with managed care processes and insurance verification protocols is essential.
Proficiency in handling medical records and understanding of relevant regulations such as HIPAA.
Strong attention to detail, organizational skills, and the ability to work independently in a fast-paced environment are crucial for success in this role.

Nice To Haves

Previous 2-5 years’ experience in a medical office or healthcare setting is preferred.
Knowledge of medical coding practices, including ICD-9 and ICD-10, is highly desirable.

Responsibilities

Verify patient insurance coverage and eligibility prior to services being rendered.
Manage CIMOR database to ensure active clients are enrolled in correct programs and are current on required reviews.
Manage and monitor billing corrections, i.e.: case labels, insurance updates, and billing codes.
Document all verification activities in the EHR accurately and promptly.
Communicate effectively with insurance companies to retrieve coverage information.
Maintain compliance with HIPAA regulations while handling sensitive patient information.
Collaborate with medical office staff to gather necessary documentation for claims processing.
Follow protocols, procedures, and policies to guide care.
Follow department workflow standards
Maintain access to state sites
Monitor monthly billing corrections and report to appropriate departments
Submit monthly reports as required
Tracking and reporting of data on spreadsheets
Complete all documentation required within the agency’s deadlines
Complies with computer security guidelines and confidentiality of both patients and staff
Maintains and supports an environment conducive to the care and welfare of clients and co-workers
Attends all required training and continuing education as required or provided
Other duties and/or responsibilities as assigned