Case Coordinator

Aperion Care; Lincolnwood (IL); Vor Ort; USD 60.000 - 80.000; Vollzeit

Zusammenfassung

Aperion Care in Lincolnwood, IL is seeking an organized Managed Care Case Manager to triage daily referral requests for Commercial, MMAI, and Medicare Advantage plans for skilled care stays. You will verify insurance details and plan benefits, acting as the key liaison among marketing, admissions, and case management teams.

The role requires understanding of Medicare rules in skilled care settings and strong multi-tasking ability. Effective communication with insurers and facilities is essential.

Qualifikationen

• Experience with Commercial and Medicare Advantage plans and claim processes.
• Skilled nursing facility environment and referral workflows.
• Two years of MCO insurance experience preferred.

Aufgaben

• Triager daily referral requests for Commercial, MMAI, and Medicare Advantage plans for skilled care stays.
• Ensure required information is present before handing off to Case Managers.
• Perform insurance verifications for commercial plans and plan benefits verifications for referrals.
• Serve as liaison between marketing, facilities admissions, and MCO Case Management.
• Review referrals for completeness and readiness for preauthorization.
• Able to maintain and close the Manage Care Referral Log.
• Assist Case Management Consultant with Auth and communications with communities and insurers.

Kenntnisse

MCO insurance experience

Organizational skills

Problem solving

Multi-tasking

Self-starter

Communication

Ausbildung

College degree

Jobbeschreibung

SUMMARY: In support of Managed Care Case Management perform the duties of triaging daily referral requests for all Commercial, MMAI, and Medicare Advantage plans for skilled care stays for all facilities. Insures all required information is provided before handing off to Case Managers. Performs insurance verifications for commercial plans as well as plan benefits verifications for all referrals.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Primary liaison between marketing liaisons, facilities admissions and MCO Case Management for new referrals and readmissions.
• Communicates and maintains effective working relationships with marketing teams, facility contacts, and case management team as relates to referral process.
• Performs review of referral requests for completeness of information and determines when ready to move to a case manager for preauthorization.
• Perform benefit verifications on all referrals adhering to appropriate processes.
• Able to hold facilities accountable to adhere to the process for referrals to case management of MCO cases.
• Maintain / Close out Manage Care Referral Log.
• Assistant to Case Management Consultant - Obtaining Auth, communication with communities, and communication with insurance companies.

QUALIFICATIONS

• College Degree is Preferred
• Experience working in a skilled nursing facility
• Understanding of how claims are paid under Commercial and Medicare Advantage plans for skilled services.
• 2 years working with MCO insurance experience is preferred
• Self-Starter and results orientated personality.
• Strong organizational, planning and problem-solving skills.
• Able to work multiple tasks before a task is completed.
• Understanding of the differences in types of insurance that is taken at a skilled nursing facility.
• Working understanding of Medicare rules as it is applied to a skilled nursing facility.

PHYSICAL DEMANDS

• Must be able to move intermittently throughout the workday.
• Must be able to speak and write the English language in an understandable manner.
• Must be able to push, pull, move, and/or lift a minimum of 25 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum of 50 feet.
• May be necessary to assist in the evacuation of residents during emergency situations.