Insurance Mgmt Specialist III-Part Time, 8am-4pm, Morristown Hybrid

Atlantic Health System; Morristown (NJ); On-site; USD 35,000 - 55,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated clerical support professional to enhance the efficiency of care management and social work teams. In this pivotal role, you will perform a variety of clerical functions, including managing communications, maintaining filing systems, and compiling essential data for monthly reports. Your attention to detail and strong analytical skills will be crucial in tracking insurance outcomes and ensuring accurate documentation. This opportunity offers a chance to work in a collaborative environment where your contributions directly support patient care and operational excellence. If you are passionate about healthcare and possess the necessary skills, this position could be your next career step.

Qualifications

• Experience in clerical support and healthcare administration.
• Strong communication skills to interact with patients and payors.

Responsibilities

• Perform clerical functions to support care management teams.
• Compile data and reports for the UR Committee monthly.

Skills

Clerical Functions

Communication Skills

Data Analysis

Attention to Detail

Education

High School Diploma

Associate Degree in Health Administration

Tools

EMR Software

Excel

PowerPoint

Epic

Job description

Responsibilities:

1. Performs clerical functions to support the care management and social work teams.
2. Fax clinical reviews to review agency and captures in designated system (EMR, CM software, etc).
3. Develop and maintain filing system as needed. Reviews, sorts and files a variety of materials.
4. Develops and maintains the following: List of review agencies, contacts, including phone and fax numbers and updates or verifies for accuracy on a regular basis.
5. Determine correct person, phone, and fax numbers to give reviews to new patients.
6. Screens and directs incoming telephone calls for department with courtesy, respect and professionalism. Distributes daily mail (internal and external) as well as emailed requests to respective CM for clinical information received from payers.
7. Pulls daily reports and communicates per Case Manager or leader in Department.
8. IM letters distribution.
9. Compiles the data and reports for UR Committee to present to the committee.
10. Creates Excel Graphs & PowerPoint slides & presents findings to the UR Committee monthly.
11. Maintain daily insurance logs & cert status in Epic.
12. Medicaid Cert Process.
13. Track 100% of commercial payer account authorization outcomes.
14. Compiles Monthly Commercial Denials, Analyzes outcomes & follows up with payor via phone or Insurance Websites.
15. Provides documentation & follow through on cases referred for outside appeal.
16. Enters Insurance information & Payor outcomes into Excel, EPIC.
17. Completes Medical Record Review on Medicaid Workque & completes Medicaid Certification review forms.
18. Coordinate Peer to Peer.
19. Liaison with HIM & Pre-Cert.
20. Follow denials process from initiation to closure & capture outcome.
21. Provide documentation and follow through on cases referred for outside appeal.
22. Completes CM Review Needed Workque & discusses missing documentation with PA’s.
23. Completes denials on PA Review forms & discusses cases with PA’s.
24. Contacts Payors to clarify & review denied days & outstanding last covered days if Payor Websites are not updated or accurate.