Assistant-Case Management

North Mississippi Health Services, Inc.; Tupelo (MS); On-site; USD 30,000 - 45,000; Full time

Job summary

North Mississippi Health Services, Inc. in Tupelo, MS is seeking an Administrative Support - Case Management to support recordkeeping, documentation, and reporting. The role handles clinical appeals and coordinates patient information for reimbursement.

You will maintain census data, generate chart audits, submit payor requests, and ensure regulatory compliance. A High School Diploma is required; an Associates degree is preferred, with strong organizational and communication skills.

Qualifications

• High School Diploma or GED required; Associates degree preferred.
• Strong organizational and communication skills required.
• Excellent interpersonal skills are essential.
• Working knowledge of medical terminology is required.

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

Skills

Organizational skills

Written and verbal communication

Interpersonal skills

Medical terminology

Education

High School Diploma or GED

Associates Degree in Business Administration or related field

Tools

Wireless paging systems

Hospital information systems

Job description

Administrative Support - CASE MANAGEMENT

Full Time - Day

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.

Job Description

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

Requirements

• High School Diploma or equivalent; required/Associates Degree in Business Administration, Office System Technology or related field; preferred
• Minimum of 1 year administrative, managerial, supervisory, clerical, or office experience; required
• Excellent organizational and communication (written and verbal) skills; required
• Working knowledge of wireless paging systems, computer systems and programs; required
• Excellent knowledge of medical terminology; required
• Effective interpersonal skills; required

Requirements

The following are requirements in addition to any stated in the above description.

Education

You must have the following education to apply:

High School Diploma, GED, or Equivalent

You must have a High School Diploma or GED or higher