Job Summary

Accountable for timely administrative processing of appeals and prior auth requests from Medicare, Medicaid, or Commercial payors. Perform administrative functions for the department under the direction of Corporate Director of Care Management or designee. Administrative tracking of appeals and prior auth requests from Medicare, Medicaid, or Commercial payers Provide administrative support to Case Management Physician Advisor (ACMO), with regards to utilization management functions, i.e., authorizations and appeals

Responsibilities

Meet the patients's needs and communicate with social worker or case coordinator regarding patient needs.Answer department phone for all General, Memorial, and W and C divisions and route calls appropriately.Payroll for Clinical Quality Management, Case Management, and Palliative Care departments.Purchase supplies and order equipment for all three divisions.Serve as custodian for department's petty cash account.Organize departments subaccounts.Update department website as needed. Compute denials and approvals in Clintrac system as it relates to patients hospital stays. Process check requests.Assist Payor Specialist Assistants on daily basis.

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact) The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department’s identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients. Competency Statement Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist. Common Duties and Responsibilities (Essential duties common to all positions) 1. Maintain and document all applicable required education. 2. Demonstrate positive customer service and co-worker relations. 3. Comply with the company's attendance policy. 4. Participate in the continuous, quality improvement activities of the department and institution. 5. Perform work in a cost effective manner. 6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations. 7. Perform work in alignment with the overall mission and strategic plan of the organization. 8. Follow organizational and departmental policies and procedures, as applicable. 9. Perform related duties as assigned.

Education 

• Associate's Degree (Required) Experience: 3 Years - Related Experience with Medicare Regulations and Reimbursement Substitution: May substitute Medical Secretary or Medical Office Technology certificate or degree and 5 years administrative experience with insurance authorization, utilization management, and appeal experience, including but not limited to Medicare, Medicaid, and Commercial insurance for the Associate Degree.

Credentials 

• No Certification, Competency or License Required

Work Schedule: Days

Status:  Full Time Regular 1.0

Location: Document Center Building

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Tamara B. Young tammy.young@vandaliahealth.org