Case Manager Extender

Berger Health System; United States; On-site; USD 34,000 - 42,000; Full time

Job summary

OhioHealth is seeking a Case Manager extender to work with interdisciplinary staff to manage patient care efficiently. Responsibilities include insurance verification, obtaining pre-authorizations, data entry, triaging calls, and directing contacts to the appropriate teams to support utilization management and care coordination.

The role emphasizes accuracy, teamwork, and timely processing to ensure payer requirements and proper charge reconciliation.

Qualifications

• High School or GED required.
• Associates degree or 3–5 years related experience.
• Proficiency in Microsoft Word, Excel, and Outlook.

Responsibilities

• Verify insurance and obtain pre-authorization when needed.
• Triaging incoming calls and directing to appropriate staff.
• Enter patient information and adjust charges as required.
• Coordinate services with utilization management and care coordination teams.
• Monitor payer accounts and reconcile charges with clinical records.
• Provide general office support and documentation as needed.

Skills

Microsoft Word

Excel

Outlook

Education

Associate’s degree

High School diploma or GED

3–5 years related experience

Job description

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more – in our careers and in our communities. Job Description Summary: The Case Manager extender works collaboratively with all interdisciplinary staff internal to OhioHealth and also external organizations to achieve timely, cost efficient and effective management of patient care. Primary responsibilities include but are not limited to: insurance verification, obtaining pre-authorization and data entry of patient information, triaging phone calls, and directing calls appropriately, status changes, entering initial and correcting inpatient room and bed charges and performing charge reconciliation.

Responsibilities And Duties

60% ASSURING APPROPRIATE PAYER AUTHORIZATION AND/OR PAYER REQUIREMENTS ARE IN PLACE FOR HOSPITAL PAYMENT.

1. 1. Responsible for insurance verification. When necessary, obtains pre-authorization from insurance companies. Interacts with physician offices and other third parties to obtain all necessary paperwork.
2. 2. Triage incoming calls within the phone processing benchmarks. Answers multi line phone system, screens calls for office/hospital associates, directing to appropriate office/hospital associate, and ensures appropriate phone coverage.
3. 3. Communicate and document accurate and appropriate information to internal and external customers. Communicates with third party payers and sends appropriate clinical information for authorization of hospital stay.
4. 4. Perform authorization data entry and coordination of services through proactive collaboration and communications with utilization management and care coordination team.
5. 5. Monitor commercial payers accounts, to include but not limited to: attachment of requested dictation to claims, addition of diagnosis allowances and authorization numbers
6. 6. Refer utilization management/clinical decisions beyond level of authority to care coordination/UM team and Manager/Director of UM team for review and decision.
7. 7. Provides general office and clerical support for office as assigned by Office Supervisor and or Manager, to include but not limited to: faxing dictation to referring physician offices, completion of disability forms, FMLA forms, Attorney request letters for reports, patient record releases, Industrial C-9s, C-84s, C-86s, Medco 17s, Industrial appeal paperwork and retroactive C-9s.
8. 8. Researching, obtaining and completing required documents for the team.
9. 9. Coordinating ancillary services according to policies
10. 10. Facilitate communication between community agencies, care coordination and utilization management team.
11. 1. Facilitates transfers of patients to alternative facilities
12. 12. Attends staff meetings
13. 13. Attends continuing in-house education seminars for further education as needed

30% PATIENT STATUS AND CHARGE RECONCILIATION

1. 1. Responsibility for updating/correcting patient status for appropriate claim drop.
2. 2. Perform charge entry to match appropriate patient status.
3. 3. Review the charge reconciliation report daily to ensure that all room and bed charges are entered correctly on a patient.
4. 4. Work in conjunction with the clinical, revenue and observation billers to correct or adjust any claims as directed by payer discussions.

10% ORGANIZATIONAL/OFFICE RESPONSIBILITIES

1. 1. Sorts, distributes, and mails transcription as assigned
2. 2. Orders and stocks office supplies.
3. 3. Ensure office equipment, are clean and well-maintained.
4. 4. Provides support to appropriate staff members as assigned

As a High Reliability Organization (HRO), responsibilities require focus on safety, quality and efficiency in performing job duties.

The job profile provides an overview of responsibilities and duties and is not intended to be an exhaustive list and is subject to change at any time.

Minimum Qualifications

• High School or GED (Required)
• Additional Job Description: Associates degree, or three to five years related Experience and/or training, or equivalent combination of and Experience . Computer competency in Microsoft Word, Excel, and Outlook, with a strong aptitude to learn other programs as needed. Ability to manage multiple priorities. Work Shift: Day Scheduled Weekly Hours : 20 Department UM Care Coord-Southwest Hub

Equal Employment Opportunity OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment

WE Are Inspired to Do Our Best. OhioHealth is a nationally recognized, innovative healthcare system delivering world-class patient care in a supportive, professional environment filled with limitless opportunities to learn and grow. We are a unique organization in the healthcare field. Our model system of facilities encompasses a wide scope of expertise and care. For professionals, we are a place where people committed to doing their best are given the tools and resources to accomplish our mission every single day. OhioHealth is recognized as a Great Place to Work CertifiedTM organization. The Great Place to Work® is a global authority on high-trust, high-performance workplace cultures. This recognition is one measure of our success in achieving a part of our vision ̶ to be an organization "where people want to work."