Job Description & Responsibilities:
UTILIZATION REVIEW - CARE MANAGEMENT: Serves as liaison with third party payers. In the normal course of duties and responsibilities, this position requires access to protected health information (PHI) and electronic protected health information (EPHI). The PHI and EPHI accessed are limited to only the minimum necessary amount of PHI and EPHI necessary to perform the functions of this job. PHI and EPHI are accessed through various computer applications, contact with the patient, Health Information Services, Case Management, and/or other System departments with whom interaction is necessary. All activities will be performed in support of the strategy, vision and values of Phoebe Putney Health System. Verify eligibility, benefits, and network status. Initiate or secure precertification for all applicable accounts according to third party payer requirements. Responds to inquiries concerning utilization review and care management activities and operations, and refers complex and / or sensitive inquiries to appropriate person(s). Communicates clinical information, under the direction of the care manager, to third party payers to maximize reimbursement. Analyzes all information provided by care managers for completeness prior to sending to third party payers for authorization. Collaborates with care manager to proactively prevent denials Promptly notifies the Appeals and Denials Coordinator of any denials, potential denials, or additional information requests from insurance companies.
Qualifications
Qualifications High School Diploma or GED (Required) 2 year / Associate Degree in Business or related field (Preferred) Work Experience 1 - 2 years insurance, utilization review, or medical terminology preferably in a Healthcare organization (Required) 1 - 2 years Proficient with computer applications like Microsoft Word and Excel and just in general use of the computer and typing information, experience with Midas would be a plus & nbsp (Preferred)
How To Apply:
Contact:
Employer: Phoebe Putney Memorial Hospital
Location: Albany, GA
Link: https://careers.phoebehealth.com/Search/JobDetails/care-management-representative/20d1a641-5f63-4e20-bcf1-2b0c4cfee508