Case Management Authorization Specialist IP at Emory Healthcare

Atlanta, Georgia, United States -

Full Time

Start Date

Immediate

Expiry Date

10 Sep, 26

Salary

29.39

Posted On

12 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Insurance Verification, Authorization Management, Care Management, Utilization Management, Clinical Documentation, Post-Acute Care Referrals, Regulatory Compliance, Patient Transition, Reimbursement Optimization, Electronic Health Records, Interdepartmental Collaboration, Payer Notification

Industry

Hospitals and Health Care

Description

Overview Be inspired. Be valued. Belong. At Emory Healthcare At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs And more Description RESPONSIBILTIES: The Case Management Authorization Specialist IP (CMAS) has a general understanding of insurance requirements as it relates to insurance verification, notification, authorization and collaboration. Primary duties and responsibilities: Care Management Inpatient Department: 1. Assists the Care Management Inpatient team to timely transition patients into post-acute services within the allotted amount of reimbursable hospital days, as determined by the clinical authorization obtained. 2. Submits referrals for securing post-acute care services as directed, which may include Home Health, Durable Medical Equipment, Subacute Rehabilitation, Inpatient Rehabilitation Facility, Long-Term Acute Care, Hospice, or Long-Term Care. 3. Prioritizes work with minimal guidance for optimal reimbursement and to avoid financial risk to both patient and hospital. 4. Ensures proper use of Care Management Systems and display adherence with workflows, which guide all responsibilities. Utilization Management Department: 1. Verify insurance eligibility and submit notice of admission (NOA) for inpatient and observation admissions to the identified primary and secondary insurances based on the payer's notification requirements and UR Department processes. 2. Verify completion of automated NOAs for appropriate insurances, and if necessary, will resubmit manually. 3. Submit appropriate admission and continued stay clinical documentation supporting services or care provided to insurances without access to Emory's Electronic Health Record based on payer's preferred method and reimbursement methodology. 4. Secures reimbursement by confirming insurance authorization determination for the inpatient or observation admission through appropriate and required communication methods. 5. Will add approved bed days to Emory's Electronic Health Record as appropriate based on authorization and reconcile authorized versus actual days to secure reimbursement for provided care. 6. Prioritizes work with minimal guidance for optimal reimbursement and to avoid financial risk to both patient and hospital. 7. Display adherence with department processes, which guide all responsibilities. Compliance: Care Management Inpatient Department: 1. Ensure regulatory requirements are met as it relates to the delivery of Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), Medicare Change of Status Notice (MCSN), and Medicare Hospital Issued Notices of Non-Coverage (HINNs) for Medicare beneficiaries as appropriate. 2. Maintains all required annual competencies, metrics, and fully participate and engage in department process improvements. Collaboration: Care Management Inpatient Department: 1. Collaborates with insurance to initiate/request authorizations for post-acute care. 2. Provides effective and efficient proactive communication to internal and external customers. 3. Assists in collaborative efforts with the Utilization Management Department, Revenue Cycle, Care Management Medical Directors, and other required departments. Minimum Qualifications: Education - High School diploma or equivalent. Experience - At least two years of experience in a healthcare setting is required. Preferred Qualifications: Education - Associate or Bachelor's degree preferred. Experience - Two years of insurance verification, authorization, or related work preferred. Additional Details Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law. Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.

Responsibilities

The specialist manages insurance authorizations and notifications for inpatient and observation admissions to ensure optimal reimbursement. They also coordinate patient transitions to post-acute services and maintain regulatory compliance for Medicare notices.