Case Management Coordinator

Apollo Medical Holdings, Inc. Monterey Park , CA 91754

Posted 2 months ago

SUMMARY

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.

QUALIFICATIONS

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.

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Case Management Coordinator

Apollo Medical Holdings, Inc.