Case Management Assistant at North… · Tupelo

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

A thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• 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: