Assistant-Case Management

North Mississippi Health Services; Tupelo (MS); On-site; USD 45,000 - 65,000; Full time

Job summary

North Mississippi Health Services is seeking a professional to support recordkeeping and documentation across hospital payer processes. The role focuses on managing appeals, coordinating medical information for reimbursement, and ensuring timely communication with insurers and regulatory bodies.

Responsibilities include chart audits, Medicaid-related tasks, and ensuring compliance with local, state, and federal guidelines while supporting staff and patients with accurate information and

Responsibilities

• Manage the reconsideration and clinical appeals processing of documents from IQH, HMS, and other 3rd party payers
• Documents and notifies insurance companies/3rd party payors of patient hospitalization to NMMC-Acute Care setting
• Coordinates the retrieval and submission of patient medical information for maximum reimbursement
• Records and communicates payor requests and authorizations
• 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)
• Maintains electronic Blue Cross/Blue Shield of Mississippi Census and other electronic census that may arise
• Generates and provides chart audit reports to appropriate personnel
• Reconciles discharge dispositions and other regulatory requirements as assigned
• Manages, documents, and tracks Medicaid TAN requests
• Electronic submission of Medicaid reviews for certification as required Clerical:
• Answers telephone calls, takes messages and responds to emails in a polite, professional manner Communication:
• Communicates effectively with staff, patients, family members, vendors and Management Customer Service:
• Provides accurate information and direction for patients, visitors, and staff; has a knowledge of hospital functions and resources
• Supports staff as needed Education:
• Maintain annual review requirements Regulatory Compliance:
• Adheres to NMHS/NMMC Policies/Procedures/Guidelines
• Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues

Job description

Posting Description
We believe a career is more than just a career — it's a calling. Our teammates's "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.

Recordkeeping/Documentation/Reporting

• Manage the reconsideration and clinical appeals processing of documents from IQH, HMS, and other 3rd party payers
• Documents and notifies insurance companies/3rd party payors of patient hospitalization to NMMC-Acute Care setting
• Coordinates the retrieval and submission of patient medical information for maximum reimbursement
• Records and communicates payor requests and authorizations
• 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)
• Maintains electronic Blue Cross/Blue Shield of Mississippi Census and other electronic census that may arise
• Generates and provides chart audit reports to appropriate personnel
• Reconciles discharge dispositions and other regulatory requirements as assigned
• Manages, documents, and tracks Medicaid TAN requests
• Electronic submission of Medicaid reviews for certification as required Clerical:
• Answers telephone calls, takes messages and responds to emails in a polite, professional manner Communication:
• Communicates effectively with staff, patients, family members, vendors and Management Customer Service:
• Provides accurate information and direction for patients, visitors, and staff; has a knowledge of hospital functions and resources
• Supports staff as needed Education:
• Maintain annual review requirements Regulatory Compliance:
• Adheres to NMHS/NMMC Policies/Procedures/Guidelines
• Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues