Case Coordinator

Aperion Care; Niles Township (IL); On-site; USD 45,000 - 65,000; Full time

Job summary

Aperion Care is seeking a referral coordination professional to triage daily referral requests for Commercial, MMAI, and Medicare Advantage plans for skilled care stays across facilities.

The role includes verifying plan benefits and coordinating with case managers, facilities, and marketing to ensure complete information is provided. A college degree and MCO experience are preferred.

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.

Responsibilities

• Triages daily referral requests for all plans for skilled care stays.
• Acts as liaison between marketing, admissions and MCO Case Management.
• Reviews referral requests for completeness before handing to a case manager.
• Performs benefit verifications on referrals per processes.
• Ensures facilities adhere to referral processes for MCO cases.
• Maintains the Manage Care Referral Log.
• Assists Case Management Consultant with authorizations and insurance communications.

Skills

MCO insurance experience

Strong organizational skills

Problem-solving

Multitasking

Education

College degree (preferred)

Job description

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

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and/or ability required.

• 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.