Community Health Systems Administrative Coordinator - Case Management / Legal / Insurance Exp. Required in St. Petersburg, Florida
Administrative Coordinator – Case Management functions:
Responsible for coordinating and supporting initiatives relative to the evaluation, processing, and handling of insurance and claims related matters.
Interacts with payers, medical staff, clinical staff and administrative staff to coordinate and manage various aspects of governmental and commercial reimbursement issues.
Coordinates Case Management Team (CMT) activities related to denial, reconsideration and recoupment issues.
Assists with preparing decision support data reports for physician and hospital based department/hospital wide quality/utilization meetings.
May assist the CMT in providing educational and in-service training to medical and hospital staff related to payer activities.
Communications with insurance representatives concerning notifications of admissions, authorizations and denials for care.
Acts as a liaison between the organization, its insurance provider and agents, and Case Managers regarding the status and eligibility for coverage.
Provides complete and accurate data for 3 rd party insurance applications, updates account as necessary.
Assist in coordination and collection of clinical reviews for renewals of authorized days from all 3 rd party payers, including Medicare, Medicaid, et al. Answers inquiries, works independently with 3 rd party insurers, gathering data and makes and makes mid level decisions on to whom and how to escalate issues, and makes recommendations as appropriate to insurers and the organization.
Set up claims and monitor activity.
Works independently in the claims denial management system, provides reports, and prepares graphic presentations.
Answer any 3 rd party payer insurance questions that may arise.
Processing of all departmental denial responses and coordinating and coordinating with finance groups as necessary related to insurance denials.
HS Diploma or Equivalent
Associates Degree Preferred.
3-5 years experience Required in Case Management, Legal or Insurance.
Must be extremely proficient in EXCEL (ie - build spreadsheets, pivot tables, etc)
Must have excellent MS Outlook and Word Skills
Job: Clerical Support
Organization: Bayfront Health St. Petersburg
Location: FL-St. Petersburg
Requisition ID: 1830064
This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment.