CASE MGMT APPEALS COORDINATOR

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  • Charleston, WV
  • Posted: May 30, 2019
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Summary

  • Basic Description
    • Accountable for timely administrative processing of appeals and prior auth requests from Medicare, Medicaid, or Commercial payors.  Perform administrative functions for the department under the direction of Corporate Director of Care Management or designee.  Administrative tracking of appeals and prior auth requests from Medicare, Medicaid, or Commercial payers   Provide administrative support to Case Management Physician Advisor (ACMO), with regards to utilization management functions, i.e., authorizations and appeals
  • Specialized Knowledge, Experience and Skills
    (Education, Experience and Skills required to fully perform the requirements of the position)
    • Degree / Education
      • Associate Degree
    • Level of Experience
      • 3 Years - Related Experience with Medicare Regulations and Reimbursement
    • Lic./Cert./Reg.
      • All licensure must be current/valid and from the state of West Virginia.
    • Typing/Word Processing skills required for this position
      • 70 wpm
    • Computer Skills required for this position
      • Basic PC Skills
      • Software knowledge
    • Other Required Areas of Knowledge, Skills and Abilities
      • Applies knowledge to new situations
      • Community Resource Knowledge
      • Customer Service
      • Decision Making
      • Employee Relations
      • Flexible Schedule
      • Handle Multiple Assignments
      • Judgment
      • Keyboarding
      • Math Simple
      • Organization
      • Problem Solving
      • Teamwork
      • Verbal Communication
      • Work Independently
      • Written Communication
    • Acceptable SUBSTITUTIONS (if any)
      • Medical Secretary or Medical Office Technology certificate or degree and 5 years administrative experience with insurance authorization, utilization management, and appeal experience, including but not limited to Medicare, Medicaid, and Commercial insurance for the Associate Degree.
    • Patient Group Knowledge (Only applies to positions with direct patient contact)
      • The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department’s identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients.
    • Assigns work to or supervises others
    • Competency Statement
      • Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist.
    • Minimum Requirement Comments
  • Physical Requirements
    (Essential physical requirements)
    • PHYSICAL REQUIREMENTS
      • Vision
      • Hearing
      • Squatting
      • Crouching/Stooping
      • Hand Coordination
      • Arm Coordination
      • Kneeling
      • Twisting Upper Body
    • Activities Requiring Time
      • Sitting - 8 hr
      • Standing - 1 hr
      • Walking - 2 hr
    • Lifting
      • Up to 10 lbs - Frequent
      • 11 to 24 lbs - Seldom
      • 25 to 50 lbs - Seldom
      • 51 to 75 lbs - N/A
      • Over 75 lbs - N/A
    • Pushing
      • Up to 10 lbs - Often
      • 11 to 24 lbs - Seldom
      • 25 to 50 lbs - N/A
      • 51 to 75 lbs - N/A
      • Over 75 lbs - N/A
    • Reaching / Pulling
      • Up to 10 lbs - Seldom
      • 11 to 24 lbs - N/A
      • 25 to 50 lbs - N/A
      • 51 to 75 lbs - N/A
      • Over 75 lbs - N/A
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Job Information

CAMC General Hospital-10
Resource Center For Case Mgmt
Full Time - Day Shift
Professional
Req #: 18169-14980

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