Case Manager Extender

About the role

The Case Manager extender works collaboratively with all interdisciplinary staff internal to OhioHealth and also external organizations to achieve timely, cost efficient and effective management of patient care.

Responsibilities

• Assuring appropriate payer authorization and/or payer requirements are in place for hospital payment (60%)
  • 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.
  • 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.
  • 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.
  • Perform authorization data entry and coordination of services through proactive collaboration and communications with utilization management and care coordination team.
  • Monitor commercial payers accounts, to include but not limited to: attachment of requested dictation to claims, addition of diagnosis allowances and authorization numbers.
  • Refer utilization management/clinical decisions beyond level of authority to care coordination/UM team and Manager/Director of UM team for review and decision.
  • 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.
  • Researching, obtaining and completing required documents for the team.
  • Coordinating ancillary services according to policies.
  • Facilitate communication between community agencies, care coordination and utilization management team.
  • Facilitates transfers of patients to alternative facilities.
  • Attends staff meetings.
  • Attends continuing in-house education seminars for further education as needed.
• Patient status and charge reconciliation (30%)
  • Responsibility for updating/correcting patient status for appropriate claim drop.
  • Perform charge entry to match appropriate patient status.
  • Review the charge reconciliation report daily to ensure that all room and bed charges are entered correctly on a patient.
  • Work in conjunction with the clinical, revenue and observation billers to correct or adjust any claims as directed by payer discussions.
• Organizational/office responsibilities (10%)
  • Sorts, distributes, and mails transcription as assigned.
  • Orders and stocks office supplies.
  • Ensure office equipment are clean and well-maintained.
  • Provides support to appropriate staff members as assigned.

Qualifications

• High School or GED (Required)
• Associates degree, or three to five years related experience and/or training, or equivalent combination of education and experience
• Computer competency in Microsoft Word, Excel, and Outlook, with a strong aptitude to learn other programs as needed
• Ability to manage multiple priorities

Schedule

Day shift, 40 scheduled weekly hours.