Case Management Financial Assistant | University | Fulltime
Apply Job ID R-4089 Date posted 12/09/2024If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!
We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South.
A Brief Overview
Coordinates review of authorization and denial information between Payers, PAS, PFS, CM's, Nursing and any other party to optimize reimbursement and decrease denial exposure on inpatients, observation patients and outpatients at Le Bonheur. Reviews denial reports, Out Of Network (OON) reports, Underpayment reports and other data to assist with timely and accurate billing processes. Assists with OON negotiations for Director review and approval as well as securing service authorizations for inpatient and observation stays when referring physicians are OON. Supports Case Managers by providing required admission notification to payers, initiating precertifications, populating Utilization Review software with days approved and denied, reviewing accounts to insure all days are approved and provides assistance with coordinating times for physician peer to peer reviews with our payers. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.
What you will do
- Identifies, monitors and reports problematic areas in the certification process, which may impact registration, billing, and reimbursement.
- Coordinates patient status, admit and/or discharge changes to facilitate correct billing.
- Enters status, admit and/or discharges changes into required systems in a timely and accurately manner.
- Provides payers with daily census and discharge data to facilitate notification and certification process for department.
- Serves as liaison with physicians and their office staff, Director of Case Management, Appeals Coordinator, case management team and payers during the denial and appeals process; assists in facilitating the process for all parties.
- Screens department correspondence pertaining to authorizations and denied claims on a daily basis and forward letters of determination to appropriate parties as well as scanning them in to appropriate systems.
- Responds to telephone inquiries and requests by physician offices and Payer as appropriate in a timely and courteous manner.
- Supports Case Managers, as needed, by initiating notification and opening a file with the correct status. Provides Case Managers the authorization number so that clinical information can be submitted.
- Utilizes multiple computer applications to research payer underpayments as needed and provides feedback to Director and/or pertinent departments. Runs revenue reports to identify changes in charge item utilization as needed.
- Assists with analysis of revenue data to identify trends and revenue improvement opportunities.
- Performs pre-certification duties for patients referred from St. Jude when the admitting physician is non-par with the plan.
- Communicates information to Patient Access Services and Patient Financial Services for accurate billing and collections.
- Negotiates rates with out of network plans for Director approval and communicates information to Patient Financial Services for accurate billing and collections.
- Troubleshoots any payment problems identified with OON accounts through communication with Patient Financial Services.
Education/Formal Training Requirements
- High School Diploma or Equivalent
- Associate's Degree Business Administration/Management
- Associate's Degree Healthcare Administration
Work Experience Requirements
- 1-3 years Billing
- 1-3 years Coding
Knowledge, Skills and Abilities
- Knowledge of medical terminology and insurance reimbursement process.
- Must be proficient in the Microsoft Office program (Word, Excel, and PowerPoint).
- Excellent written and verbal communication skills.
- Proficient in use of basic office equipment; multi-line phones; and data entry.
- Ability to set priorities coordinates tasks, organize tasks and maintain control of workflow.
- Ability to evaluate problematic situations and be able to adapt, respond to, and/or notify/advise appropriate staff in order to resolve the situation/issue.
Supervision Provided by this Position
- There is no supervisory or lead responsibilities assigned to this job.
Physical Demands
- The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
- Must have good balance and coordination.
- The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
- The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
- The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.
Our Associates are passionate about what they do, the service they provide and the patients they serve. We value family, team and a Power of One culture that requires commitment to the highest standards of care and unity.
Education:
Associate's Degree: Business Administration/Management (Required), Associate's Degree: Healthcare Administration (Required), High School Diploma or EquivalentWork Experience:
Billing, CodingCertifications:
Boasting one of the South's largest medical centers, Memphis blends a friendly community, a thriving and growing downtown, and a low cost of living. We see each day as a new opportunity to make a difference in the lives of the people in our community.