Managed Care Coordinator - Franklin, United States - American Health Partners

American Health Partners Franklin, United States

4 weeks ago

Description

JOB SUMMARY:
This position is responsible for receiving, screening and processing all managed care authorizations on recertification as well as requested part B authorizations

ESSENTIAL JOB DUTIES:
To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

Receive, screen and process all authorization requests Perform verification of benefits:
o Verify benefits o Verify payment method and amount o Obtain prior authorization to ensure that services are reimbursable prior to admission o Assign appropriate payer category to be keyed by facility personnel o Scan information back to requesting facility Ensure timely and accurate processing of all authorization requests to include notification of facility BOC and Rehab Manager (part B only) Answers phones for resident information dissemination Organize workload to complete responsibilities in an appropriate and timely manner

REQUIRED QUALIFICATIONS:

Experience:
o Three (3) years' experience in a healthcare related environment preferred o Exposure to healthcare marketing a plus Education/License/Certification(s): o Nurse license in good standing, LPN or RN required

SUPERVISORY RESPONSIBILITES:

Does not have supervisory responsibilities Occasionally needs manager's direction due to extraordinary circumstances EQUAL OPPORTUNITY EMPLOYER This Organization is an equal opportunity employer.

We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws.

This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.

I understand the contents of this job description are a summary, that they are intended as guidelines only, and it may be amended at any time.

The effectiveness of any changes does not depend on receiving notice thereof. I have reviewed this job description. I understand my job duties and responsibilities prior to signing this form. I certify that I can perform the essential functions and attest that I possess the qualifications as outlined.

Furthermore, I understand future performance evaluations are based on my ability to perform the duties and responsibilities outlined in this job description to the satisfaction of my immediate supervisor.

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