Case Management Financial Asst – North – FT/Days Job

Company Name: Methodist Le Bonheur Healthcare

Location: Memphis, TN, US - 37501

Job Duration: 2022-01-13 to 2022-02-12

Overview

Summary

Coordinates review of authorization and denial information between Payers, PAS, PFS, CM’s, Nursing and any other party to optimize reimbursement and decrease denial exposure on inpatients, observation patients and outpatients at Le Bonheur.  Reviews denial reports, Out Of Network (OON) reports, Underpayment reports and other data to assist with timely and accurate billing processes.  Assists with OON negotiations for Director review and approval as well as securing service authorizations for inpatient and observation stays when referring physicians are OON.  Supports Case Manager’s by providing required admission notification to payers, initiating precertifications, populating Utilization Review software with days approved and denied, reviewing accounts to insure all days are approved and provides assistance with coordinating times for physician peer to peer reviews with our payers. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Education/Experience/Licensure

 

Education/Formal Training

Work Experience

Credential/Licensure

 

REQUIRED:

Associate’s Degree in Business Administration, Healthcare Management, or related field.

Two (2) years of experience in billing and/or insurance in an acute care setting.

N/A

 

PREFERRED:

N/A

N/A

N/A

 

SUBSTITUTIONS ALLOWED:

Three (3) years of directly related experience in Case Management or Revenue Cycle Operations.

N/A

N/A

Knowledge/Skills/Abilities

  • Knowledge of medical terminology and insurance reimbursement process.
  • Must be proficient in the Microsoft Office program (Word, Excel, and PowerPoint).
  • Excellent written and verbal communication skills.
  • Proficient in use of basic office equipment; multi-line phones; and data entry.
  • Ability to set priorities coordinates tasks, organize tasks and maintain control of workflow.
  • Ability to evaluate problematic situations and be able to adapt, respond to, and/or notify/advise appropriate staff in order to resolve the situation/issue. 

Key Job Responsibilities

  • Identifies, monitors and reports problematic areas in the certification process, which may impact registration, billing, and reimbursement.
  • Maintains and communicates all insurance related issues or needs.
  • Coordinates or assists in coordination of activities, events and meetings supporting department objectives.
  • Utilizes multiple computer applications to research payer underpayments as needed and provides feedback to Director and/or pertinent departments.
  • Troubleshoots any payment problems identified with OON accounts through communication with Patient Financial Services.

Physical Requirements

  • The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
  • Must have good balance and coordination.
  • The physical requirements of this position are: light work – exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
  • The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
  • The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.