Assist Case Managers in assigned area of responsibility, including compiling information (open & close inpatient cases), fax authorization letters to providers, including sending denial letters and keeping records. Provide and coordinate information with outside agencies.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
Comply with CM policies and procedures. Annual review of selected CM policies.
Provide support to case managers on day-to-day activities
Sort, stamp and distribute incoming faxes
Create authorization/tracking numbers for all hospital admissions
Obtain in-patient reviews and follow-up discharge dates as assigned
Communicate with Hospitals, SNF, and Rehab on status authorization (tracking, pending, denied)
Provide authorization(s) for services requested on discharge (i.e., DME, Home Health, others)
Update Access line on-call schedule on a monthly basis
Update authorization notes to include the status of tracking number (approved, denied or pending)
Notify Case Managers if admission is either approved or denied
Notify Case Managers of out-of-network hospital admissions for medical review
Monitor OB-inpatient admissions
Assist in researching problems that occur in case management department in a timely fashion
Responsible for follow-up and returning department calls
File and scan hospital records as assigned
Report to supervisor on activities or problems occurring throughout the day
Attend to provider or interdepartmental calls in accordance with exceptional customer service
Perform other duties, projects and actions as assigned
Maintains strictest confidentiality at all times
Possess adept understanding of health plan division of financial responsibilities (DOFR), audit requirements, and delegation agreements
Participate in additional tasks as requested by the supervisor, manager, and/or medical director related to coordinator's scope of duties.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
High School Graduate or equivalent
A minimum of 2 years experienced in managed care environment to include but not limited to an IPA or MSO
Knowledge of medical terminology, RVS, CPT, HPCS, ICD-9 codes
Proficient with Microsoft Office (Word, Excel, Power Point) and EZCAP
Good organizational skills.
Excellent written and oral communication skills, as well as strong interpersonal, critical thinking and analytical skills.
Must have the ability to multitask and problem solve in a fast pace work environment
Personal & Professional Qualities
Punctuality, detail oriented, creativity, etc. would be helpful for this position
Ability to follow directions and perform work independently according to department standards
Able to function effectively under time constraint
Able to maintain confidentiality at all times
Willingness to accept responsibility and desire to learn new task
Must be a strong team player, punctual and have excellent attendance record.
Apollo Medical Holdings, Inc.