Case Manager

Pentec Health - Glen Mills, PA3.7

30+ days agoFull-timeEstimated: $57,000 - $77,000 a year
Skills
Objective:
As a member of the intake team, the Case Manager is responsible for the coordination of care to new patients, explanation of benefits, goals of care and the expectations for service provided through Pentec Health, Inc. In addition, the Case Manager serves as an integral resource to the Revenue Cycle Management department to ensure reimbursement of services.

Essential Duties & Responsibilities:
Provides clinical expertise in home infusion therapies; managing internal aspects during intake process of therapy prescribed and assisting with all clinical aspects needed for appeals of authorizations and outstanding accounts receivable.
Assists with the reimbursement of services by reviewing clinical documentation as needed and analyze documentation provided as part of the referral process to minimize the fragmentation of care within the healthcare delivery system.
Manages the daily activities of new accounts within a team environment and directs the process of these accounts to ensure they are on-boarded in a timely manner.
Contact new patients, answer any questions, and serve as an additional ongoing clinical contact. Review with the patient the on-boarding process which includes the financial obligations of the patient associated with the service.
Serve as a resource and problem solver for patients and their caregivers, nurses, pharmacists, reimbursement coordinators, intake and insurance coordinators payer relations personnel, sales and marketing representatives, patients and their caregivers.
Collaborate with Pentec professionals in preparing for Joint Commission reviews. Initiate and participate in audits to assess and improve compliance.
Supports and adheres to HIPAA guidelines and Pentec Health policies and procedures with respect to patient privacy practices and standards of care.
Provides a collaborative approach between patient and provider to advocate for professional excellence and quality outcomes.
Develop and maintain ongoing relationships with key professionals at payor sources in an effort to provide education regarding Pentec TDD services. Pursue out of network or participate in peer reviews when needed to ensure reimbursement for our services.
Works under minimum supervision, confers with supervisor/manager on difficult assignments.
Attends appropriate educational in-services as directed by supervisor
May be responsible for travel up to 25% to field sites to support clinical and sales efforts.
Provide ongoing training & mentorship to other members of the intake team.
Required to maintain current licensure/certification and the ability to obtain outside state licenses/certifications as needed.

Skills, Competencies and Experience:
Required

Registered Nurse from an accredited school of Nursing or Bachelors of Social work or other health or human service field that promotes the physical and psychosocial well-being of the persons being served.
Knowledge of insurance process and intake coordination
Excellent communication and customer service abilities
Excellent organizational and process skills
Ability to work under pressure and meet timelines
Familiarity with Joint Commission standards
Thorough understanding of HIPAA requirements.
Preferred

3-5 years of case management experience
3-5 years of clinical experience in home infusion therapy.
Proficiency with CPR+
Skilled in the Appeals and Denials of claims process

Education, Certifications, Trainings:
Required

Registered Nurse from an accredited school of Nursing or Bachelors of Social work or other health or human service field that promotes the physical and psychosocial well-being of the persons being served.
Preferred

Bachelors of Science in Nursing (BSN) strongly preferred
Baccalaureate or Graduate degree in social work or other health or human service field that promotes the physical, psychosocial well-being of the persons being served
Certified Case Manager (CCM) or Certified Registered Nurse Infusion (CRNI)
Exceptional computer skills with programs such as Microsoft Office Suite: Outlook, Word, Excel and Power Point
Dependable automobile with safe driving record and current driver’s license/insurance policy