Case Manager – Behavioral Health
Advocate Aurora Health
full-time
Posted on:
Location Type: Office
Location: Macon • United States
Visit company websiteExplore more
Salary
💰 $27 - $40 per hour
About the role
- Coordinates the patient’s care throughout their stay
- Collaborates with the health care team in evaluating the appropriate use of resources, such as medications, procedures, protocols, and tests
- Ensures progress towards departmental improvement goals relative to length of stay (LOS) and cost per case
- Identifies need for referral to appropriate discipline
- Participates in Care Conferences as requested
- Engages in utilization management activities appropriate to the patient’s level of care
- Maintains an informed status of reimbursement plans, requirements, and guidelines for hospitalization and alternate level of care services
- Communicates status to the health care team
- Contacts the attending physician and other health care providers whenever additional information is needed for assessment, care planning, or reimbursement purposes
- Obtains insurer’s approval for services by providing the insurer with pertinent medical information
- Ensures progress towards departmental goals for denial management
- Collaborates with the health care team (nurse, pharmacist, physician, therapist, Physician) in monitoring appropriateness of test/procedures, medications, consultations, and treatment plans
- In conjunction with Social Service, handles Hospital Issued Notice of Non-Coverage (HINN)
- Coordinates insurance approvals and obtains pre-certs for all payer sources
- Documents insurance information/authorization numbers in relative software applications
- Documents calls and related information on designated forms
- Establishes and maintains positive relationships with patients, physicians, allied professionals, and all peers
- Supports facility internal and external customer service standards
- Participates in training and development activities to enhance own knowledge and skills
- Reviews all cases to assure admission criteria is met
- Communicates to the physician if further documentation is needed by regulatory regulations
- Assist with chart audits from outside insurance companies
- Writes appeals as needed to insurance companies
- Arranges peer to peer reviews with physicians and insurance companies
- Reports any known compliance issues to Director and Assistant Director of Coordinated Care and Director of BH Financial Operations/Revenue Cycle Operations
Requirements
- Bachelor's degree in Business, Education, Counseling, Human Services or related field from an accredited institute
- Minimum of two years’ experience in the care of assigned patient population
- Working knowledge of community resources
- Expert knowledge of ICD, CPT, and HCPCS coding guidelines
- Expert knowledge of medical terminology, anatomy, and physiology
- Expert ability to identify coding quality issues/concerns and provide recommendations for improvement
- Expert ability to analyze trends and data and display them in a statistical reporting format
- Expert organization and communication (verbal and written) skills
- Expert ability to effectively train others through oral and/or written methods
- Expert organization, prioritization, and reading comprehension skills
- Expert analytical skills, with high attention to detail
- Expert knowledge of Microsoft Office, video and web conferencing, email, and experience with electronic coding and EHR systems or applications
- Expert knowledge of care delivery documentation systems and related medical record documents
- Expert interpersonal communication skills (oral and written) necessary to collaborate with Physicians, other clinicians, and Professional Coding Department team members and leadership
- Ability to work independently and exercise independent judgment and decision-making
- Ability to meet deadlines while working in a fast-paced environment
- Ability to take initiative and work collaboratively with others
- Strong sense of ethics
- Experience with remote workforce operations required.
Benefits
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
ICD codingCPT codingHCPCS codingmedical terminologyanatomyphysiologydata analysisstatistical reportingEHR systemscare delivery documentation
Soft Skills
organizationcommunicationtrainingprioritizationanalytical skillsattention to detailinterpersonal communicationindependent judgmentinitiativeethics