Case Management Assistant

We believe a career is more than just a career — it's a calling. Our teammates' "True North" is what calls them to health care; it’s their passion. At North Mississippi Health Services, we believe in helping you leverage and connect that passion with a much greater purpose that impacts people you know and love. Department: 10007910 Case Management Work Shift: NA Job Description: The Case Management Assistant at North Mississippi Health Services is responsible for maintaining and facilitating communication and documentation regarding patient stay, insurance, and the case management area function.

This includes coordinating on clinical appeals, payer notifications and authorizations, electronic census, and Medicaid requests and reviews. This role engages strong organizational and communication skills to maintain accurate and organized documentation and interface with internal and external stakeholders including payers, staff, patients, and families in an effective and professional manner.

JOB FUNCTIONS Recordkeeping/Documentation/Reporting: • Manages the reconsideration and clinical appeals processing of documents from IQH, HMS, and other 3rd party payers. • Documents and notifies insurance companies/3rd party payors of patient hospitalization to NMMC-Acute Care setting. • Coordinates the retrieval and submission of patient medical information for maximum reimbursement. • Records and communicates payor requests and authorizations. • Retrieves requested medical information and submits to insurance company/3rd party payor for post-acute care coordination (i.e.

UM Reviews including clinicals, Discharge Plan). • Maintains electronic Blue Cross/Blue Shield of Mississippi Census and other electronic census that may arise. • Generates and provides chart audit reports to appropriate personnel. • Reconciles discharge dispositions and other regulatory requirements as assigned. • Manages, documents, and tracks Medicaid TAN requests. • Completes electronic submission of Medicaid reviews for certification as required. Clerical: • Answers telephone calls, takes messages and responds to emails in a polite, professional manner. Communication : • Communicates effectively with staff, patients, family members, vendors and Management.

Customer Service: • Provides accurate information and direction for patients, visitors, and staff; has a knowledge of hospital functions and resources. • Supports staff as needed. Education: • Maintains annual review requirements. Regulatory Compliance: • Adheres to NMHS/NMMC Policies/Procedures/Guidelines. • Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues.

Knowledge Skills and Abilities • Excellent organizational and communication (written and verbal) skills; required • Working knowledge of wireless paging systems, computer systems and programs; required • Excellent telephone etiquette; required • Excellent knowledge of medical terminology; required • Effective interpersonal skills…

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