Description

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

• Under the supervision of the Director of Case Management (DCM) or designee, completes various duties to enhance the efficiency of the Case Management Department, as well as support the daily functions of the Case Managers
• This role assists in securing arrangements for the discharge transition and post-acute services. Works with the Case Management team to monitor and obtain insurance verifications and concurrent authorizations
• Assists with denial prevention and management as requested, aiding with the peer-to-peer coordination, and denials / appeals tracking
• This position serves as a liaison between the Case Management department, payers, post-acute providers and various other entities
  
  

Essential Functions

• Provides assistance to the Case Management staff, including, but not limited to; creating and sending referral packets, organizing admission and discharge patient records, making phone calls, obtaining signatures, or any other assistance needed as determined by the DCM
• Assists the Case Management team in scheduling family conferences
• Assists the Case Management team by making necessary arrangement for post-discharge follow-up care
• Functions as the point of contract and liaison for the hospital Case Management department staff regarding clinical insurance review completion and/or issues
• Forwards the necessary patient clinical information for all admission, concurrent, and retrospective insurance reviews to payers for the completion of medical necessity reviews
• Monitors, follows-up, documents and tracks payer responses / requests of completed clinical reviews, including approvals, appeals and denials and communicates these to the appropriate people (hospital staff, physicians, DCM, Case Manager(s), Clinical Denial Management, and Centralized Business Office {CBO})
• Monitors and tracks the total hospital certified days of the patient for payers (commercial, managed care, and Medicaid) and communicates missing certifications to the DCM, Case Manager(s), and CBO
• Initiates and completes insurance pre-certification for patients lacking certification. Communicates pre-authorization outcomes to appropriate individuals (hospital and CBO)
• Organizes and prepares the necessary clerical elements for the weekly Interdisciplinary Team Meeting and other Case Management meetings
  
  

Knowledge/Skills/Abilities/Expectations

• Must read, write and speak fluent English
• Must have good and regular attendance
• Ability to learn logistics of insurance verification and certification process, case management and discharge planning tasks
• Clinical knowledge to read, interpret, and communicate information in the medical record that identifies diagnoses, treatment plans, interventions and medical necessity for hospitalization
• Knowledge of Medicare benefits and insurance processes and contracts
• Knowledge of accreditation standards and compliance requirements
• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation / collaboration from hospital leadership, as well as physicians, payers and other external customers
• Ability to work under stress, multitask, and to respond quickly in urgent situations
• Performs other related duties as assigned
• Approximate percent of time required to travel: 0%
  
  

Salary Range: $27.08 - $39.60/Hour

Qualifications

Education

• College degree in a healthcare related field preferred
  
  

Licenses/Certification

• None required
  
  

Experience

• 1 year in a healthcare setting