Arnot Health
Join to apply for the
Case Manager - Case Management
role at
Arnot Health 2 months ago Be among the first 25 applicants Join to apply for the
Case Manager - Case Management
role at
Arnot Health Get AI-powered advice on this job and more exclusive features. Remote work available!
Up to $10,000 Sign on Bonus for qualified Case Managers!
Main Function
The Case Management (denial/prior auth) will review and appeal as appropriate for concurrent and retrospective authorization and denial activities for Arnot Health. Identify, track and trend, record and collect patient accounts denied by payer. Under the direction of the System Director of Care Coordination coordinates data with other Arnot Health departments and third party payers to discourage preventable denials Brief Description
Remote work available!
Up to $10,000 Sign on Bonus for qualified Case Managers!
Main Function
The Case Management (denial/prior auth) will review and appeal as appropriate for concurrent and retrospective authorization and denial activities for Arnot Health. Identify, track and trend, record and collect patient accounts denied by payer. Under the direction of the System Director of Care Coordination coordinates data with other Arnot Health departments and third party payers to discourage preventable denials
Duties And Responsibilities
Retrospectively determines medical necessity and appropriateness of admission and stay in accordance with InterQual Criteria to assist with appeal of denials Maintains a working knowledge of the requirements of 3rd party payers Reviews denials from third party payers obtained from correspondence and or payments. Assists in tracking/trending by payer for denial reason items such as prior authorization, untimely filing, coordination of benefits, services type issues, and insurance or service verification. Identify patterns of common denial errors, types and recurring issues. Facilitates, coordinates and prepares denial appeals working with internal and external customers in a proactive manner to bring satisfactory resolution in coordination with other department staff Relays denial information to appropriate billing clerks and management. Follow up on denial claims using reports to ensure completion of appeal with other department staff Interacts with physicians and other Arnot Health departments in matters of auth/denial review decisions. Maintains a working relationship with Physician Advisor regarding physician issues related to auths/denials. Provide insurance companies with requested patient information as needed. Maintains a working knowledge of programs necessary for denial management (ie: excel, word, QCPR, Sorian, InterQual, eCW) Maintains files and all letters of non-coverage. Tracks and trends denial activity in coordination with other department staff. Maintains a working relationship with Finance and Corporate Compliance officers with regard to denial activity. Is responsible for attending all mandatory annual educational programs as required by the position. Employee understands and demonstrates the importance of satisfying the needs of the customer/patient by interacting with him/her in a friendly and caring way, being attentive to the customer’s needs, both psychologically and physically, and by taking the initiative to maintain communication with the customer in order to provide and secure and pleasant experience with the Arnot Health. It is understood that this lists typical duties for the classification and is not to be considered inclusive of all duties that may be assigned.
Meetings
Case management staff meetings. Case management staff development meetings. Auth/Denial Management meetings
Education
EDUCATION:
RN required.
Experience
NYS licensed Registered Nurse required. Bachelor’s in nursing preferred. Must have proficient writing skills.
Cardiopulmonary Resuscitation (cpr) Requirements
Experience in Utilization Review and InterQual required.
BLS preferred.
Physical Demands
Routine office job. Light physical effort
Exposure Category
Category III. Tasks that involve no exposure to blood, body fluids or tissues. Category I tasks are not a condition of employment. Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
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Case Manager - Case Management
role at
Arnot Health 2 months ago Be among the first 25 applicants Join to apply for the
Case Manager - Case Management
role at
Arnot Health Get AI-powered advice on this job and more exclusive features. Remote work available!
Up to $10,000 Sign on Bonus for qualified Case Managers!
Main Function
The Case Management (denial/prior auth) will review and appeal as appropriate for concurrent and retrospective authorization and denial activities for Arnot Health. Identify, track and trend, record and collect patient accounts denied by payer. Under the direction of the System Director of Care Coordination coordinates data with other Arnot Health departments and third party payers to discourage preventable denials Brief Description
Remote work available!
Up to $10,000 Sign on Bonus for qualified Case Managers!
Main Function
The Case Management (denial/prior auth) will review and appeal as appropriate for concurrent and retrospective authorization and denial activities for Arnot Health. Identify, track and trend, record and collect patient accounts denied by payer. Under the direction of the System Director of Care Coordination coordinates data with other Arnot Health departments and third party payers to discourage preventable denials
Duties And Responsibilities
Retrospectively determines medical necessity and appropriateness of admission and stay in accordance with InterQual Criteria to assist with appeal of denials Maintains a working knowledge of the requirements of 3rd party payers Reviews denials from third party payers obtained from correspondence and or payments. Assists in tracking/trending by payer for denial reason items such as prior authorization, untimely filing, coordination of benefits, services type issues, and insurance or service verification. Identify patterns of common denial errors, types and recurring issues. Facilitates, coordinates and prepares denial appeals working with internal and external customers in a proactive manner to bring satisfactory resolution in coordination with other department staff Relays denial information to appropriate billing clerks and management. Follow up on denial claims using reports to ensure completion of appeal with other department staff Interacts with physicians and other Arnot Health departments in matters of auth/denial review decisions. Maintains a working relationship with Physician Advisor regarding physician issues related to auths/denials. Provide insurance companies with requested patient information as needed. Maintains a working knowledge of programs necessary for denial management (ie: excel, word, QCPR, Sorian, InterQual, eCW) Maintains files and all letters of non-coverage. Tracks and trends denial activity in coordination with other department staff. Maintains a working relationship with Finance and Corporate Compliance officers with regard to denial activity. Is responsible for attending all mandatory annual educational programs as required by the position. Employee understands and demonstrates the importance of satisfying the needs of the customer/patient by interacting with him/her in a friendly and caring way, being attentive to the customer’s needs, both psychologically and physically, and by taking the initiative to maintain communication with the customer in order to provide and secure and pleasant experience with the Arnot Health. It is understood that this lists typical duties for the classification and is not to be considered inclusive of all duties that may be assigned.
Meetings
Case management staff meetings. Case management staff development meetings. Auth/Denial Management meetings
Education
EDUCATION:
RN required.
Experience
NYS licensed Registered Nurse required. Bachelor’s in nursing preferred. Must have proficient writing skills.
Cardiopulmonary Resuscitation (cpr) Requirements
Experience in Utilization Review and InterQual required.
BLS preferred.
Physical Demands
Routine office job. Light physical effort
Exposure Category
Category III. Tasks that involve no exposure to blood, body fluids or tissues. Category I tasks are not a condition of employment. Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Arnot Health by 2x Get notified about new Manager Case Management jobs in
Elmira, NY . Corning, NY $123,572.00-$169,912.00 1 month ago Corning, NY $123,572.00-$169,912.00 1 day ago Manager, Arrhythmia Center - Arrhythmia Center - Full Time - Up to a $25,000 Sign On Bonus
Assistant Nurse Manager - 5D Stepdown/Cardiac
RN Case Manager - Case Management - Full Time Day
Supervisor, Assistant Clinical Manager RN - Operating Room - Full Time
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Supervisor, Clinical RN - Behavioral Health Sciences - Full Time
RN Acute Case Manager - System Care Management - Full Time Day
Supervisor, Clinical RN - Nursing Unit - 9 SW - Full Time
Supervisor, Clinical RN - Nursing Administration - Full Time
Supervisor, Clinical RN - 5 Main Oncology - Full Time
RN - Registered Nurse Unit Manager - Long Term Care Unit
Supervisor, Clinical RN - Nursing Unit - 9 SW - Full Time
Supervisor, Clinical RN -Med/Surg Nursing - 6 NW - Full Time
Supervisor, Clinical RN - Med/Surg Nursing - 6 NW - Full Time
Supervisor, Clinical RN - Med/Surg Nursing - 6 NW - Full Time
Supervisor, Clinical RN - Med/Surg Nursing - 8 NW - Full Time
Corning, NY $80,000.00-$90,000.00 3 weeks ago RN Care Coordinator - Medical Plan - Full Time Day
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr