Strength Through Diversity
Ground breaking science. Advancing medicine. Healing made personal.
To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring it reaches the responsible individuals. Must also maintain accurate record keeping via either electronic documentation within the hospital Eagle and Canopy systems or written record keeping. Responsible for accurate filing of records, obtaining medical records and mailing of both internal and external correspondence.
Is cognizant of the philosophy, standards, objectives and policies of the Department and the Hospital Center.
- Prioritizes Insurance Requests / Denials when received in the department as per protocol
- Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews
- Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in Allscripts
- Meets time frame for reviews / appeals as specified by Insurance / State & Federal regulation.
- Enters concurrent review information for Review Nurses in Allscripts
- Obtains/Prepares Medical Records and other documentation for Photo Copying Service, outside 2nd party and / Discharge Appeals
- Maintain the integrity of the Medical Record.
- Utilizes Hospital Mainframe programs and Allscripts Systems effectively
- Process Mail - Sort, identifies location and distribute to appropriate departments
- Monitors Concurrent Nurse denial phone calls for UM Nurse to follow
- Prioritizes work as per department protocol (IPRO Discharge Appeals / Insurance requests)
- Support Appeals Nurse / Manager by confirming status of denials
- Tracking status of Medical Record requests for denials to insure that they are received timely
- Completes assignments based on priorities
Associate degree; applicable work experience may be considered in lieu of educational requirements.
Strong clerical skills required
Very Strong Computer skills on Excel and Word
Strong Communication skills