Case Management Assistant

LE101 North Mississippi Medical Center, Inc; Portland (OR); On-site; USD 23,000 - 34,000; Full time

Job summary

North Mississippi Health Services is seeking a Case Management Assistant to maintain communication and documentation for patient stays, insurance, and case management coordination. You will interface with payers, staff, patients, and families with professionalism.

The role emphasizes strong organization, attention to detail, and the ability to work independently or in a team while handling multiple tasks in a fast-paced hospital setting.

Qualifications

• Excellent organizational and communication (written and verbal) skills; required.
• Working knowledge of wireless paging systems, computer systems and programs; required.
• Excellent telephone etiquette; required.
• Excellent knowledge of medical terminology; required.
• Effective interpersonal skills; required.
• Must be able to work independently as well as in a group setting.
• Must be able to organize and prioritize work assignments.
• Must be able to keep records accurate and confidential.
• Must be able to manage with multiple interruptions.
• Extensive contact with: Director of the department, clinical and support staff, insurance companies and 3rd party payors.
• Must demonstrate telephone etiquette and effective interpersonal skills.
• Must have excellent written and verbal communication skills.
• Must reflect a positive, caring attitude toward clients, patients, staff and the public we serve.
• Must be self-motivated.

Responsibilities

• Manages 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.
• Completes electronic submission of Medicaid reviews for certification as required.
• Answers telephone calls, takes messages and responds to emails in a polite, professional manner.
• Communicates effectively with staff, patients, family members, vendors and Management.
• Provides accurate information and direction for patients, visitors, and staff; has a knowledge of hospital functions and resources.

Skills

Organizational skills

Verbal communication

Written communication

Medical terminology

Interpersonal skills

Independent work

Time management

Confidential records

Multitasking

Telephone etiquette

Stakeholder coordination

Team collaboration

Positive attitude

Education

Associate degree in Business Administration/Management

High School Diploma or GED

Job 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.

Department: 10007910 Case Management Work Shift: NA

Job Description: 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 Medicaid 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.

JOB FUNCTIONS

Recordkeeping/Documentation/Reporting:

• Manages 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.
• Completes 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:

• Maintains annual review requirements.

Regulatory Compliance:

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

Knowledge Skills and Abilities

• Excellent organizational and communication (written and verbal) skills; required
• Working knowledge of wireless paging systems, computer systems and programs; required
• Excellent telephone etiquette; required
• Excellent knowledge of medical terminology; required
• Effective interpersonal skills; required
• Must exhibit excellent organizational and communication skills
• Must be able to work independently as well as in a group setting
• Must be able to organize and prioritize work assignments
• Must be able to keep records accurate and confidential
• Must be able to manage with multiple interruptions
• Must have extensive contact with: Director of the department, clinical and support staff , insurance companies and 3rd party payors
• Must demonstrate telephone etiquette and effective interpersonal skills
• Must have excellent written and verbal communication skills
• Must reflect a positive, caring attitude toward clients, patients, staff and the public we serve
• Must be self-motivated
• Must have the ability to work independently as well as in a group setting

Physical Demands

• Standing. Constantly
• Walking. Frequently
• Sitting. Rarely
• Lifting/Carrying. Frequently 50 lbs
• Pushing/Pulling. Frequently
• Climbing. Occasionally
• Balancing. Occasionally
• Stooping/Kneeling/Bending. Frequently
• Reaching/Over Head Work. Frequently
• Grasping. Frequently
• Speaking. Occasionally
• Hearing. Constantly
• Repetitive Motions. Constantly
• Eye/Hand/Foot Coordinations. Frequently

Salary Range: $16.62 - $24.93 Education: Associate’s Degree | Business Administration/Management | Not Required High School Diploma, GED, or Project Search Graduate | Business Administration/Management | Required

Certifications: North Mississippi Health Services is a large rural health care system with state-of-the-art facilities in Mississippi and Alabama. We have career opportunities ranging from inpatient hospital care to 70+ rural health and specialty clinics, a variety of outpatient, women’s and behavioral health services and many additional support services. Our team of over 7,000 works together every day toward our shared mission - to continuously improve the health of the people of our region.