5 Case Manager: Prior Authorization - REMOTE Jobs in Houston, TX
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Case Manager: Prior Authorization - REMOTE
$84k-101k (estimate)
Full Time
2 Days Ago
LivaNova is Hiring a Remote Case Manager: Prior Authorization - REMOTE
Join us today and make a difference in people's lives!LivaNova is a global medical technology company built on nearly five decades of experience and a relentless commitment to improving the lives of patients around the world. Our advanced technologies and breakthrough treatments provide meaningful solutions for the benefit of patients, healthcare professionals, and healthcare systems. The company is listed on the NASDAQ stock exchange under the ticker symbol “ LIVN .” LivaNova is headquartered in London (UK) with a presence in over 100 countries and a team of more than 3,000 employees worldwide.
LivaNova NeuromodulationAs pioneers of the VNS (Vagus Nerve Stimulation) Therapy® system, LivaNova continues to advance medical device solutions for patients affected by Drug-Resistant Epilepsy (DRE) and Difficult-to-Treat Depression (DTD). There are 3 million people in the U.S. alone and one on three people with epilepsy are drug resistant. People with severe seizures have, on average, a shorter life expectancy and an increased risk of cognitive impairment particularly if the seizures developed in early childhood. VNS Therapy for DRE is delivered through a device that sends mild pulses to the vagus nerve at regular intervals throughout the day in an effort to prevent seizures
The PACM is primarily responsible for the coordination and implementation of the financial (insurance) approval aspect for individuals referred by their treating physicians for vagus nerve stimulation surgery.
The process is initiated by the PACM following receipt of a physician signed patient identification and qualification (PIQ) form as well as a referral from the territory case manager (assigned to the particular patient).
The PACM is responsible for completion of payer required forms and medical necessity letter (when required) and payer submission (per payer requirements).
In the event a payer requires submission by service provider via payer portal, PACM will assist service provider according to provider preference.
The PACM is responsible for payer follow-up specific to submitted authorizations and updating database appropriately. This role maintains communication with others involved in the verification and care coordination process, including but not limited to the territory Case Manager, Verification Specialist & Reimbursement Specialist. Prior Authorization Case Managers (PACMs) collaborate) to ensure that authorization needs are met within an acceptable timeframe.
The PACM reports to the Case Management Manager.
Primary Activities
Our Commitment To Diversity & InclusionLivaNova values equality and celebrates diversity. We are committed to ensuring that our recruitment process is fair, transparent and free from unlawful discrimination.Our selection process is driven by the key demands/requirements for the role rather than bias or discrimination on the basis of a candidate’s sex, gender identity, age, marital status, veteran status, non-job-related disability/handicap or medical condition, family status, sexual orientation, religion, color, ethnicity, race or any other legally protected classification. Notice To Third Party AgenciesPlease note that we do not accept unsolicited resumes from recruiters or employment agencies. In the absence of a signed Recruitment Services Agreement, we will not consider, or agree to, payment of any referral compensation or recruiter fee. In the event that a recruiter or agency submits a resume or candidate without a previously signed agreement, we explicitly reserve the right to pursue and hire those candidate(s) without any financial obligation to the recruiter or agency.Beware Of Job ScamsPlease beware of potentially fraudulent job postings or suspicious recruiting activity by persons posing as LivaNova recruiters or employees. The scammers may attempt to solicit confidential, personal information, such as a social security number, or your financial information. LivaNova will never ask for fees prior/during/after the application process, nor will we ask for banking details or personal financial information in return for the assurance of employment. If you are concerned that an offer of employment might be a scam or that the recruiter is not legitimate, please verify by searching for “See Open Jobs” on https://www.livanova.com/en-us/careers, and check that all recruitment emails come from an @livanova.com email address.
LivaNova NeuromodulationAs pioneers of the VNS (Vagus Nerve Stimulation) Therapy® system, LivaNova continues to advance medical device solutions for patients affected by Drug-Resistant Epilepsy (DRE) and Difficult-to-Treat Depression (DTD). There are 3 million people in the U.S. alone and one on three people with epilepsy are drug resistant. People with severe seizures have, on average, a shorter life expectancy and an increased risk of cognitive impairment particularly if the seizures developed in early childhood. VNS Therapy for DRE is delivered through a device that sends mild pulses to the vagus nerve at regular intervals throughout the day in an effort to prevent seizures
The PACM is primarily responsible for the coordination and implementation of the financial (insurance) approval aspect for individuals referred by their treating physicians for vagus nerve stimulation surgery.
The process is initiated by the PACM following receipt of a physician signed patient identification and qualification (PIQ) form as well as a referral from the territory case manager (assigned to the particular patient).
The PACM is responsible for completion of payer required forms and medical necessity letter (when required) and payer submission (per payer requirements).
In the event a payer requires submission by service provider via payer portal, PACM will assist service provider according to provider preference.
The PACM is responsible for payer follow-up specific to submitted authorizations and updating database appropriately. This role maintains communication with others involved in the verification and care coordination process, including but not limited to the territory Case Manager, Verification Specialist & Reimbursement Specialist. Prior Authorization Case Managers (PACMs) collaborate) to ensure that authorization needs are met within an acceptable timeframe.
The PACM reports to the Case Management Manager.
Primary Activities
- Serves as a resource to other members of the PACM team, providing guidance specific to insurance/payer issues and authorization submissions and follow-up (Team Leader)
- Reviews clinical documentation and determines completeness of clinical notes and prior workup documentation
- Coordinates with territory case manager to fill gaps in clinical notes and obtain prior workup documentation
- Completes and submits VNS surgery authorization requests to health care plan(s) as requested by the health care provider (including payer specific forms)
- Provides draft letter of medical necessity to physician provider upon request
- Communicates with payer(s)/health care plan(s) for status update of previously submitted authorization requests
- Assists with payor appeals process to achieve approval or until appeal options are exhausted in the event of a prior authorization request denial
- Serves as resource to physician providers as well as other LivaNova team members specific to the authorization process
- Assists physicians and hospitals with pre-surgical reimbursement coding and denial appeals as needed
- Attends local, regional or national meetings, educational seminars & symposia as required
- Collaborates with other PACM team members to identify changes in payer policies specific to VNS surgery authorizations as well as any payer specific trends in authorization processing; and works with other team members in developing strategies to address any negative trends
- Educates physicians and case managers on appropriate clinical documentation needed to support the prior authorization process
- Performs other duties as required by management
- Maintains current training as required by LivaNova and the Case Management Department
- Bachelor of Science or Vocational/Practical degree in Nursing (LVN-LPN); or Master’s prepared Social Worker.
- 5 years of experience and understanding in coding and billing, prior authorization, patient education, and coordination of care. (preferably with Neurology, Mental Health, Cardiac, Cardiac Surgery, Neurosurgery within a practice or facility),
- Exceptional written, telephonic, and verbal communication skills, with internal and external customers at all levels
- Familiarity with various software/programs, including Word, Excel, PowerPoint, Microsoft Outlook & Microsoft One Note
- Good organizational skills with the ability to multi-task and prioritize
- Ability to work independently; self-starter with results orientation
- Excellent interpersonal skills with evidence of teamwork and collaboration
- Demonstrated commitment to the LivaNova mission
Our Commitment To Diversity & InclusionLivaNova values equality and celebrates diversity. We are committed to ensuring that our recruitment process is fair, transparent and free from unlawful discrimination.Our selection process is driven by the key demands/requirements for the role rather than bias or discrimination on the basis of a candidate’s sex, gender identity, age, marital status, veteran status, non-job-related disability/handicap or medical condition, family status, sexual orientation, religion, color, ethnicity, race or any other legally protected classification. Notice To Third Party AgenciesPlease note that we do not accept unsolicited resumes from recruiters or employment agencies. In the absence of a signed Recruitment Services Agreement, we will not consider, or agree to, payment of any referral compensation or recruiter fee. In the event that a recruiter or agency submits a resume or candidate without a previously signed agreement, we explicitly reserve the right to pursue and hire those candidate(s) without any financial obligation to the recruiter or agency.Beware Of Job ScamsPlease beware of potentially fraudulent job postings or suspicious recruiting activity by persons posing as LivaNova recruiters or employees. The scammers may attempt to solicit confidential, personal information, such as a social security number, or your financial information. LivaNova will never ask for fees prior/during/after the application process, nor will we ask for banking details or personal financial information in return for the assurance of employment. If you are concerned that an offer of employment might be a scam or that the recruiter is not legitimate, please verify by searching for “See Open Jobs” on https://www.livanova.com/en-us/careers, and check that all recruitment emails come from an @livanova.com email address.
Job Summary
JOB TYPE
Full Time
SALARY
$84k-101k (estimate)
POST DATE
06/26/2024
EXPIRATION DATE
07/24/2024
WEBSITE
vygen.com
HEADQUARTERS
Bryn Mawr, PA
SIZE
<25
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