Assistant Case Management

North Mississippi Health Services; Pontotoc (MS); On-site; USD 32,000 - 42,000; Full time

Job summary

The Case Management Assistant at North Mississippi Health Services is responsible for maintaining and facilitating communication and documentation regarding patient stay, insurance, and the case management area function. This includes coordinating on clinical appeals, payer notifications and authorizations, electronic census, and payer requests and reviews.

This role engages strong organizational and communication skills to maintain accurate and organized documentation and interface with

Qualifications

• Maintain required annual education and competency requirements.

Responsibilities

• Notify insurance companies and third-party payors of patient hospital admissions
• Coordinate retrieval and submission of medical records to support reimbursement and authorization processes?
• Track, record, and communicate payor requests and authorization statuses?
• Retrieves requested medical information and submits to insurance company/3rd party payor for post-acute care coordination (i.e. UM Reviews including clinicals, Discharge Plan).
• Maintain Blue Cross/Blue Shield of Mississippi and other electronic census reports?
• Generate chart audit reports and distribute to appropriate personnel?
• Reconcile discharge dispositions and meet regulatory documentation requirements?
• Manages, documents, and tracks Medicaid TAN requests.
• Completes electronic submission of Medicaid reviews for certification as required.
• Communicate effectively with staff, patients, families, vendors, and leadership; provide accurate information and guidance to patients, visitors, and staff; support department operations to ensure a positive patient experience?
• Maintain required annual education and competency requirements?

Job description

Posting Description

We believe a career is more than just a career — it's a calling. Our teammates' "True North" is what calls them to health care; it’s their passion. At North Mississippi Health Services, we believe in helping you leverage and connect that passion with a much greater purpose that impacts people you know and love.

#WhatConnectsYou

#NMHSConnections

Job Summary

The Case Management Assistant at North Mississippi Health Services is responsible for maintaining and facilitating communication and documentation regarding patient stay, insurance, and the case management area function. This includes coordinating on clinical appeals, payer notifications and authorizations, electronic census, and payer requests and reviews. This role engages strong organizational and communication skills to maintain accurate and organized documentation and interface with internal and external stakeholders including payers, staff, patients, and families in an effective and professional manner.

Recordkeeping/Documentation/Reporting

JOB FUNCTIONS

• Notify insurance companies and third-party payors of patient hospital admissions
• Documents and notifies insurance companies/3rd party payors of patient hospitalization to NMMC-Acute Care setting.
• Coordinate retrieval and submission of medical records to support reimbursement and authorization processes?
• Track, record, and communicate payor requests and authorization statuses?
• Retrieves requested medical information and submits to insurance company/3rd party payor for post-acute care coordination (i.e. UM Reviews including clinicals, Discharge Plan).
• Maintain Blue Cross/Blue Shield of Mississippi and other electronic census reports?
• Generate chart audit reports and distribute to?appropriate personnel?
• Reconcile discharge dispositions and meet regulatory documentation requirements?
• Manages, documents, and tracks Medicaid TAN requests.
• Completes electronic submission of Medicaid reviews for certification as required.

Communication

• Communicate effectively with staff, patients, families, vendors, and leadership?Provide?accurate?information and guidance to patients, visitors, and staff?Support department operations to ensure a positive patient experience?

Education

• Maintain required annual education and competency requirements?

Patient Support

• Perform follow-up assessment as needed and report findings to licensed Case Manager.
• Send referrals as determined by licensed Case Manager
• Coordinate and track authorizations for inpatient stays, home health services, and post acute referrals
• Monitor referral status and ensure timely completion

Regulatory Compliance

• Adheres to NMHS/NMMC Policies/Procedures/Guidelines.
• Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues.