Case Management Authorization Specialist IP

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RESPONSIBILTIES:

• The Case Management Authorization Specialist IP (CMAS) has a general understanding of insurance requirements as it relates to insurance verification notification authorization and collaboration.
• Primary duties and responsibilities: Care Management Inpatient Department: 1. Assists the Care Management Inpatient team to timely transition patients into post-acute services within the allotted amount of reimbursable hospital days as determined by the clinical authorization obtained. 2. Submits referrals for securing post-acute care services as directed which may include Home Health Durable Medical Equipment Subacute Rehabilitation Inpatient Rehabilitation Facility Long-Term Acute Care Hospice or Long-Term Care. 3. Prioritizes work with minimal guidance for optimal reimbursement and to avoid financial risk to both patient and hospital. 4. Ensures proper use of Care Management Systems and display adherence with workflows which guide all responsibilities.
• Utilization Management Department: 1. Verify insurance eligibility and submit notice of admission (NOA) for inpatient and observation admissions to the identified primary and secondary insurances based on the payers notification requirements and UR Department processes. 2. Verify completion of automated NOAs for appropriate insurances and if necessary will resubmit manually. 3. Submit appropriate admission and continued stay clinical documentation supporting services or care provided to insurances without access to Emorys Electronic Health Record based on payers preferred method and reimbursement methodology. 4. Secures reimbursement by confirming insurance authorization determination for the inpatient or observation admission through appropriate and required communication methods. 5. Will add approved bed days to Emorys Electronic Health Record as appropriate based on authorization and reconcile authorized versus actual days to secure reimbursement for provided care. 6. Prioritizes work with minimal guidance for optimal reimbursement and to avoid financial risk to both patient and hospital. 7. Display adherence with department processes which guide all responsibilities.
• Compliance: Care Management Inpatient Department: 1. Ensure regulatory requirements are met as it relates to the delivery of Important Message from Medicare (IMM) Medicare Outpatient Observation Notice (MOON) Medicare Change of Status Notice (MCSN) and Medicare Hospital Issued Notices of Non-Coverage (HINNs) for Medicare beneficiaries as appropriate. 2. Maintains all required annual competencies metrics and fully participate and engage in department process improvements.
• Collaboration: Care Management Inpatient Department: 1. Collaborates with insurance to initiate/request authorizations for post-acute care. 2. Provides effective and efficient proactive communication to internal and external customers. 3. Assists in collaborative efforts with the Utilization Management Department Revenue Cycle Care Management Medical Directors and other required departments.
  
  

Minimum Qualifications:

• Education - High School diploma or equivalent.
• Experience - At least two years of experience in a healthcare setting is required.
• Preferred Qualifications: Education - Associate or Bachelors degree preferred.
• Experience - Two years of insurance verification authorization or related work preferred.
  
  PHYSICAL REQUIREMENTS: (Medium): 20-50 lbs; 0-33% of the work day (occasionally); 11-25 lbs 34-66% of the workday (frequently); 01-10 lbs 67-100% of the workday (constantly); Lifting 50 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking Occasional sitting Close eye work (computers typing reading writing) Physical demands may vary depending on assigned work area and work tasks.
  
  ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste. Chemicals/gases/fumes/vapors Communicable diseases Electrical shock Floor Surfaces Hot/Cold Temperatures Indoor/Outdoor conditions Latex Lighting Patient care/handling injuries Radiation Shift work Travel may be required. Use of personal protective equipment including respirators and environmental conditions may vary depending on assigned work area and work tasks.

Emory is an equal opportunity employer and qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcares Human Resources at . Please note that one weeks advance notice is preferred.