Payer Notification Specialist - Case Management, PRN

KNOX COMMUNITY HOSPITAL; Mount Vernon (OH); On-site; USD 24,796 - 35,817; Full time

Job summary

Knox Community Hospital is seeking a Payer Notification Specialist in Case Management for PRN hours. You will notify insurance payers of admissions, secure pre-certifications, and resolve authorization issues to ensure timely patient placement.

The role requires knowledge of Medicare/Medicaid payers, medical terminology, ICD10/CPT coding, and healthcare experience, with strong communication and multitasking abilities to thrive in a demanding environment.

Qualifications

• Must have problem-solving and multitasking abilities.
• Excellent customer service and telephone communication skills.
• Able to adapt to change and stay composed under pressure.
• PC literacy with Windows, email, and internet navigation; ability to type.
• Experience with health insurance authorizations preferred.

Responsibilities

• Comply with local, state and federal regulations
• Timely submission of patient information
• Verify pre-certification and/or authorizations in HIS system
• Update authorization as needed
• Maintain confidentiality and safety of patients, staff and information
• Support the mission, values and vision of the organization
• Assist in the orientation and training of new personnel
• Maintain effective communication with internal and external customers
• Participate in staff meetings and mandatory in-services
• Demonstrate initiative in personal/professional development

Skills

Problem solving

Multitasking

Customer service

Telephone communication

Adaptability

PC literacy

Typing

Work under pressure

Education

High School Diploma

Medical terminology, ICD10 and CPT coding skills

Medicare/Medicaid payer knowledge

Healthcare experience 3-5 years

Job description

Payer Notification Specialist - Case Management, PRN

Job Specifics

Case Management

Status

PRN

Shift

Saturdays and Sundays, 8:00 am - 2:30 pm

Notifies insurance payers of member admission (and observation if required). Secures all necessary hospital admission and observation /authorizations pre-certifications in a timely manner. Reviews and resolves pre-authorization/pre-certification issues. Responsible for notifying appropriate hospital personnel of insurance and benefit updates and changes, upon discovery. Responsible for gathering and submitting all necessary clinical documentation with pre-certification/authorization initially and as directed by insurance payer and Case Management leadership. Adheres to organizational policies and procedures; regulatory/accrediting body requirements and professional practice standards, including Health Insurance Portability and Accountability Act (HIPPA).

PRIMARY JOB RESPONSIBILITIES

• Comply with all local, state and federal regulations
• Timely submission of patient information
• Verifies that all pre-certification and/or authorizations have been obtained and documented in the HIS system
• Will update authorization or pre-certification as needed
• Assumes responsibility and accountability for individual knowledge, skills, performance and behavior in accordance with hospital, division and department standards of care and policies and procedures
• Utilizes measures to promote and maintain patient, visitor and personnel safety
• Maintains patient, employee, physician and organization confidentiality; respects the rights, privacy and property of others
• Supports the mission, values and vision of the organization

ADDITIONAL RESPONSIBILITIES

• Assists in the orientation and training of new personnel
• Demonstrates knowledge of disaster/emergency procedures and responds appropriately
• Maintain effective communication with all internal and external customers providing outstanding quality of service
• Perform tasks that are supportive in nature to the essential functions of the job
• Participate in staff meetings, educational programs, committees, QI activities and mandatory in-services
• Demonstrate initiative in personal/professional development
• Presents a professional image
• Assist with costs through the judicious use of human and material resources
• Other duties as assigned

Requirements Include

EDUCATION AND WORK EXPERIENCE

• High School Diploma
• Medical terminology, ICD10 and CPT coding skills required.
• Knowledge of third party payer processes preferred and compliance regulations processes
• Knowledge of Medicare and Medicaid payers
• 3-5 years healthcare experience required
• Experience with insurance authorizations preferred

KNOWLEDGE AND SKILLS

• Must be able to problem-solve multi-task and work independently
• Must have outstanding customer service and telephone communication skills
• Must be able to adjust to change
• Must be PC literate with skills in windows, email and internet navigation
• Must be able to type
• Must be able to perform professionally during high stress and high patient volume times