Case Management Assistant

About the role

The Case Management Assistant at MD Anderson Cancer Center provides support services to ensure pre-certification, authorization, and payment for inpatient services, while facilitating the acquisition of equipment and services necessary to support the continuum of care. This role works closely with patients, families, insurance payors, vendors, and the interdisciplinary healthcare team to help ensure timely care transitions and successful discharge planning.

Responsibilities

• Provide support services to ensure pre-certification, authorization, and payment for inpatient services and facilitate the continuum of care for patients
• Carefully coordinate acquisition of equipment between insurance companies, vendors, healthcare teams, and patients/family members
• Review patient medical records to provide clinical information to insurance payors for services
• Review patient medical records to obtain authorization for continued inpatient hospitalization
• Ensure completeness of Certificates of Medical Necessity (CMNs), including diagnosis codes, medical documentation, and length of need requirements
• Document information necessary to facilitate appeals for denied services, insurance verification, benefits verification, and discharge planning
• Obtain missing insurance information from patients as appropriate
• Communicate insurance and Medicare issues with patients, access centers, interdisciplinary team members, and other departments involved in patient care
• Reconcile and maintain task lists to assign and reassign utilization reviews
• Utilize CARE, Maxsys, InterQual, and CARE templates for documentation
• Maintain durable medical equipment (DME) vendor relationships
• Other duties as assigned

Requirements

• Education Required: Associate's Degree in Business Administration, Healthcare Administration, or related field
• Experience Required: Three years of administrative experience in healthcare, insurance, or related field; with a preferred degree, one year of related experience may be considered

Qualifications

• Education Preferred: Bachelor's Degree in Business, Healthcare Administration, or related field

Skills

• Excellent communication skills
• Strong organizational and time management skills
• Ability to work independently and as part of a team
• Knowledge of healthcare regulations and insurance processes

Benefits

MD Anderson Offers Our Employees: Paid employee medical benefits (zero premium), Group Dental, Vision, Life, AD&D, and Disability coverage, Paid Time Off (PTO) and Extended Illness Bank (EIB) paid leave accruals, Paid institutional holidays, wellness leave, childcare leave, and other paid leave programs, Tuition Assistance Program after six months of service, Teachers Retirement System defined benefit pension plan and two voluntary retirement plans, Employer paid life, AD&D, and illness related reduced salary pay program, Health Savings Account and Dependent Care Reimbursement flexible spending accounts, Fertility benefits, State of Texas longevity pay, Extensive wellness, recognition, fitness, employee health programs, and employee resource groups

Pay

Hourly breakdown of salary range: Minimum $21.88 | Midpoint $27.40 | Maximum $32.93

Schedule

Onsite Pivotal Position: No