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Company Name : Confidential-Healthcare Services
Location : Orange County, CA
Position : Administrative Outpatient Case Manager-Work From Home
Job Description : Compensation: Negotiable Based On Experience Employment type: full-time Telecommuting okay and encouragedCASE MANAGER- Work From Home (LA Metro)Compensation: Negotiable Based On Experience Employment type: full-time Telecommuting okay and encouragedESSENTIAL DUTIES AND RESPONSIBILITIES include but are not limited to being responsible for assessing, preparing and properly finalizing referral cases for surgery in a timely manner and in accordance with the practice timelines.QUALIFICATIONS: 5+ Years of Experience in Medical administrative work intake/preauthorizations, knowledge of the full revenue cycleSpecific duties include assessing and processing cases by checking medical benefits, obtaining current eligibilities, contacting patients/parents/guardians for case information, following up on submitted authorizations, preparing, sending and obtaining pre-admit forms for review and signature, uploading documents to accounts, reviewing and processing authorization replies, researching in-network options while filing grievances with members and their insurance, collecting deposits and cash payments, scheduling approved cases accordingly, discussing case issues with your team and/or designated referral staff to resolve these patient issues, maintaining live schedules on-line with Google Sheets in cooperation with the referral offices, analyzing and resolving insurance or financial issues, running and submitting reportsMaintaining a daily tracking record of case progress summaries and statuses, releasing case status to client upon request and attending case management conference calls or meetingsAssess daily referral paperwork for completeness and accuracy, request and obtain missing information in a timely mannerSet up cases to track their progress until properly finalized and approved to be scheduledPre-vet cases by phone with patients, guardians, conservators, and/or social workers including but not limited to conducting a demographic intake, completing a full medical history and discussing our program attributes via patient orientationContact insurance companies to obtain benefits and perform a thorough insurance verification process for the benefitsConduct monthly eligibility checks on the 1st of every month for all active casesRequest authorization submission to team members and confirm submission to insurance payorsFollow up on authorization submission with health plans and IPAs until receivedPrepare, send and obtain pre-admit forms to patients for signature prior to date of surgeryUpload documents to accounts such as signed forms, insurance card, letters of guardianship, notices, correspondence accordingly to case files etc.Review authorization replies to ensure CPT codes were authorized properly. If denied, determine approach and strategy for timely implementationResearch in-network options for care, track data and file grievances with the member and their health plan, document details in the case notesCollect deposits for PPO/HMO/EPO cases, document in the notes and upload receiptsCollect cash payments for cases without a benefit option basedInsert notes into EMR for each case with details related to progress on finalizing the case, status updates, follow up calls, contact detailsAssign reason codes to each case based on the status of the case at any given step of the way; indicate case status notes including reference numbers, contact name and phone numberAssist referral office team and schedule approved cases on the LIVE schedule by date of serviceParticipate in team conference calls to discuss case issues and analyze outcomes for case strategyContact designated referral office staff to assist in the processing of their referred casesRun weekly reports for case status to share with the referral office for their reference and scheduling; review case status and work report to finalize casesMaintain daily case status log for tracking progress and quantifying tasks completed each day for the practiceMeet or exceed timelines associated with finalizing cases properly for schedulingCommunicate effectively and often with client, administrator and team about issues with cases and provide solutionsBe readily available via phone, text or email to discuss case situations, challenges or problemsAccept and learn from constructive direction and criticism with regards to decision making and case processingInteract with patient/parent/guardian for the good of establishing a relationship to promote and ensure the program requirements are maintainedPlease respond by sending your resume with relevant experience in Medical Administrative/Intake/Preauthorizations/Billing with contact information so that a phone and personal interview can be conducted. Spanish and Arabic speaking is a plus.Job Types: Full-time, ContractPay: Up to $30.00 per hourSchedule:Monday to FridayWeekend availabilityCOVID-19 considerations:Remote positionExperience:healthcare: 5 years (Preferred)Administrative: 5 years (Preferred)Language:Spanish or Arabic (Preferred)Work Location: Remote
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