Payer Notification Specialist - Case Management, PRN

Payer Notification Specialist - Case Management, PRN Job Specifics Case Management Status PRN Shift Saturdays and Sundays, 8:00 am - 2:30 pm Notifies insurance payers of member admission (and observation if required). Secures all necessary hospital admission and observation /authorizations pre-certifications in a timely manner. Reviews and resolves pre-authorization/pre-certification issues. Responsible for notifying appropriate hospital personnel of insurance and benefit updates and changes, upon discovery. Responsible for gathering and submitting all necessary clinical documentation with pre-certification/authorization initially and as directed by insurance payer and Case Management leadership. Adheres to organizational policies and procedures; regulatory/accrediting body requirements and professional practice standards, including Health Insurance Portability and Accountability Act (HIPPA).

PRIMARY JOB RESPONSIBILITIES

Comply with all local, state and federal regulations Timely submission of patient information Verifies that all pre-certification and/or authorizations have been obtained and documented in the HIS system Will update authorization or pre-certification as needed Assumes responsibility and accountability for individual knowledge, skills, performance and behavior in accordance with hospital, division and department standards of care and policies and procedures Utilizes measures to promote and maintain patient, visitor and personnel safety Maintains patient, employee, physician and organization confidentiality; respects the rights, privacy and property of others Supports the mission, values and vision of the organization

ADDITIONAL RESPONSIBILITIES

Assists in the orientation and training of new personnel Demonstrates knowledge of disaster/emergency procedures and responds appropriately Maintain effective communication with all internal and external customers providing outstanding quality of service Perform tasks that are supportive in nature to the essential functions of the job Participate in staff meetings, educational programs, committees, QI activities and mandatory in-services Demonstrate initiative in personal/professional development Presents a professional image Assist with costs through the judicious use of human and material resources Other duties as assigned Requirements Include EDUCATION AND WORK EXPERIENCE High School Diploma Medical terminology, ICD10 and CPT coding skills required. Knowledge of third party payer processes preferred and compliance regulations processes Knowledge of Medicare and Medicaid payers 3-5 years healthcare experience required Experience with insurance authorizations preferred

KNOWLEDGE AND SKILLS

Must be able to problem-solve multi-task and work independently Must have outstanding customer service and telephone communication skills Must be able to adjust to change Must be PC literate with skills in windows, email and internet navigation Must be able to type Must be able to perform professionally during high stress and high patient volume times #J-18808-Ljbffr KNOX COMMUNITY HOSPITAL