Case Management Authorization Specialist - Emory Healthcare/Emory University

Overview



Be inspired. Be rewarded. 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, and leadership programs...and more!

Description

The

Case Management Authorization Specialist

follows developed policies and procedures to obtain insurance eligibility and benefits by identifying correct insurance plan and determining coordination of benefits with minimal guidance. Responsible for informing the care team and financial counseling of any discrepancies identified related to coordination of benefits and/or coverage as it relates to ineligible coverage, non-covered services or out of network status. Secondary to verification of eligibility, provides notification of admission for inpatient and observation stays to the identified payer within the payers required timeframe in order to secure reimbursement for services provided. Upon completion of notification of admission, responsible for confirming clinical authorization by communicating patient and clinical information, medical necessity, and level of care to payers to secure account for reimbursement by following payers established guidelines as it relates to clinical authorization and review. + Responsible for reconciliation of clinical days authorized versus patient actual days in order to confirm reimbursement for provided care. + The Case Management Authorization Specialist functions with minimal oversight and guidance with a general understanding of payor requirements as it relates to insurance verification, notification, and authorization. + Case Management Specialist may specialize in certain payors but overall a generalist within the department. + Assists with providing technical and clerical support, as directed, to the Case Management team in order to timely transition patients into post-acute services within the allotted amount of reimbursable hospital days, as determined by the clinical authorization obtained. + Facilitates referral process, as directed, for securing post-acute care services which can include: Home health, Durable Medical Equipment, Rehab, Hospice, Long Term Care. + Collaborate with insurance case managers to initiate/request authorizations for post-acute care. + Ensures regulatory requirements are met as it relates to the MOON and IMM. + Prioritizes work with minimal guidance for optimal reimbursement and to avoid financial risk to both patient and hospital. + Ability to multi task in a fast paced environment while efficiently handing multiple priorities and ensuring deadlines are met. + The Case Management Authorization Specialist will ensure proper use of Case Management Systems and display adherence with workflows. + Must meet all quality and productivity expectations, including successful completion of yearly competencies.

MINIMUM REQUIREMENTS:

+ High school education diploma or equivalent. + College degree preferred. + At least two years of experience in a healthcare setting is required. + Two (2) years of insurance verification, authorization, or related work preferred.

Additional Details



Supporting a diverse, equitable and inclusive culture.

Emory Healthcare (EHC) is dedicated to providing equal opportunities and access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression and/or veteran's status. EHC does not discriminate on the basis of any factor stated above or prohibited under applicable law. EHC respects, values, and celebrates the unique perspectives and backgrounds of all individuals. EHC aspires to create an environment of collaboration and true belonging for all our patients and team members. _Emory Healthcare (EHC) is committed to achieving a diverse workforce through equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training._

ACCOMODATIONS:

EHC will provide reasonableaccommodationsto qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Office of Diversity, Equity, and Inclusion. PHYSICAL REQUIREMENTS: (Medium-Heavy) 36-75 lbs, 0-33% of the work day (occasionally); 20-35 lbs, 34-66% of the workday; (frequently); 10-20 lbs, 67-100% of the workday (constantly); Lifting 75 lbs max; Carrying of objects up to 35 lbs; Occasional to frequent standing & walking; Occasional sitting; Close eye work (computers, typing, reading, writing); Physical demands may vary depending on assigned work area and work tasks. ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure; Bio-hazardous waste Chemicals/gases/fumes/vapors; Communicable diseases; Electrical shock; Floor Surfaces; Hot/Cold Temperatures; Indoor/Outdoor conditions; Latex; Lighting; Patient care/handling injuries; Radiation; Shift work; Travel may be required; Use of personal protective equipment, including respirators; environmental conditions may vary depending on assigned work area and work tasks.

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Division

_Emory Univ Hosp-Midtown_

Campus Location

_Atlanta, GA, 30308_

Campus Location

_US-GA-Atlanta_

Department

_EHM Utilization Review_

Job Type

_Regular Full-Time_

Job Number

_137392_

Job Category

_Clerical & Administrative_

Schedule

_8a-4:30p_

Standard Hours

_40 Hours_

Hourly Minimum

_USD $20.10/Hr._

Hourly Midpoint

_USD $26.13/Hr._ Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status or any other classification protected by applicable federal, state, or local law.