Acute Case Manager Extender

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more – in our careers and in our communities.

The Case Manager extender works collaboratively with all interdisciplinary staff internal to Ohio Health and also external organizations to achieve timely, cost efficient and effective management of patient care. Primary responsibilities include but are not limited to: insurance verification, obtaining pre-authorization and data entry of patient information, triaging phone calls, and directing calls appropriately, status changes, entering initial and correcting inpatient room and bed charges and performing charge reconciliation.

The case manager extender is well organized, highly motivated, customer service oriented and expresses good communication skills.

60%

ASSURING APPROPRIATE PAYER AUTHORIZATION AND/OR PAYER REQUIREMENTS ARE IN PLACE FOR HOSPITAL PAYMENT.
1. Responsible for insurance verification. When necessary, obtains pre-authorization from insurance companies. Interacts with physician offices and other third parties to obtain all necessary paperwork.
2. Triage incoming calls within the phone processing benchmarks. Answers multi line phone system, screens calls for office/hospital associates, directing to appropriate office/hospital associate, and ensures appropriate phone coverage.
3. Communicate and document accurate and appropriate information to internal and external customers. Communicates with third party payers and sends appropriate clinical information for authorization of hospital stay.
4. Perform authorization data entry and coordination of services through proactive collaboration and communications with utilization management and care coordination team.
5. Monitor commercial payers accounts, to include but not limited to: attachment of requested dictation to claims, addition of diagnosis allowances and authorization numbers
6. Refer utilization management/clinical decisions beyond level of authority to care coordination/UM team and Manager/Director of UM team for review and decision.
7. Provides general office and clerical support for office as assigned by Office Supervisor and or Manager, to include but not limited to: faxing dictation to referring physician offices, completion of disability forms, FMLA forms, Attorney request letters for reports, patient record releases, Industrial C-9s, C-84s, C-86s, Medco 17s, Industrial appeal paperwork and retroactive C-9s. 8. Researching, obtaining and completing required documents for the team.

9. Coordinating ancillary services according to policies 10. Facilitate communication between community agencies, care coordination and utilization management team. 1 1. Facilitates transfers of patients to alternative facilities 12. Attends staff meetings 13. Attends continuing in-house education seminars for further education as needed

30%

PATIENT STATUS AND CHARGE RECONCILIATION
1. Responsibility for updating/correcting patient status for appropriate claim drop.
2. Perform charge entry to match appropriate patient status.
3. Review the charge reconciliation report daily to ensure that all room and bed charges are entered correctly on a patient.
4. Work in conjunction with the clinical, revenue and observation billers to correct or adjust any claims as directed by payer discussions.

10%

ORGANIZATIONAL/OFFICE RESPONSIBILITIES
1. Sorts, distributes, and mails transcription as assigned
2. Orders and stocks office supplies.
3. Ensure office equipment, are clean and well-maintained.
4. Provides support to appropriate staff members as assigned

As a High Reliability Organization (HRO), responsibilities require focus on safety, quality and efficiency in performing job duties.

The job profile provides an overview of responsibilities and duties and is not intended to be an exhaustive list and is subject to change at any time

High School or GED (Required)

Associates degree, or three to five years related Experience and/or training, or equivalent combination of and Experience . Computer competency in Microsoft Word, Excel, and Outlook, with a strong aptitude to learn other programs as needed. Ability to manage multiple…