Community Health Systems Administrative Coordinator - Case Management / Legal / Insurance Exp. Required in St. Petersburg, Florida

Description:

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.

Qualifications

Education

  • HS Diploma or Equivalent

  • Associates Degree Preferred.

Experience:

  • 3-5 years experience Required in Case Management, Legal or Insurance.

  • Must have excellent MS Outlook, Word and Excel Skills

Job: Clerical Support

Organization: Bayfront Health St. Petersburg

Location: FL-St. Petersburg

Requisition ID: 1830064