Case Management Representative PRN Lake Main Campus
Case Management Representative PRN Lake Main Campus
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
The Case Management Representative (CMR) coordinates the daytoday operations of Utilization Management by providing all insurance companies with the information required to obtain approved days. Directing all denials and appeals to the appropriate person or team. The CMR will submit reviews in a timely manner for payers. Review index and/or respond appropriately to payer communication via OnBase. The CMR provides all communication with the insurance company to obtain approved days for the patients encounter. Serves as the liaison between various departments in the hospital including HIM Business Office physicians offices and Access Services. Coordinates Medical Management Tracker denial log and TQ reports. This position is responsible for communicating the essential information to obtain approved for bed days from the insurance company. This communication is the driver for the payment received from the insurance company.
Responsibilities
- Daily Operations
- Receives calls from payors and records data in a complete and accurate format. Makes written and verbal inquiries to obtain data in a prompt and efficient manner.
- Coordinates the daily operations of Utilization Review obtains the clinical information and forwards to payors to complete for certification. Completes all incomplete certification for all patients.
- Communicates with providers to verify actual dates of services and other information needed in an effort to ensure efficient departmental operations.
- Coordinates and prepares letters sent to internal and external customers in a prompt and efficient manner.
- Quality
- Ensures data of certification placed into the system is accurate maintains reliable data records and source documents and informs appropriate personnel of changes in a timely manner.
- Uses Interqual criteria to assist the Clinical Resource Coordinators in retrieving clincal information and abstracting for weekend Retro Reviews for providers.
- Faxes all completed forms and clinical documentation to providers. Maintains and organizes faxes in an effort to ensure the quality and efficiency of health care service delivery.
- Other Duties As Assigned
- Performs other duties as assigned or requested.
Qualifications
Education High School or equivalent.
Experience 1 year Medical Billing and Coding
Required Experience:
Unclear Seniority
Employment Type
Gig
