What are the responsibilities and job description for the Certified Case Manager - Pre-Authorizations & Case Reviews position at PayerFusion Holdings LLC?
Job Description
Job Description
JOB DESCRIPTION
About Us :
We are a service-based company and as a licensed Third-Party Administrator, we are seeking only top talent and experienced personnel in order to meet and exceed our client's expectations. We’re an innovative company creating a unique experience for healthcare professionals. While many industry-wide solutions exist, nothing comes close to our ground-breaking approach.
Job Summary :
We are seeking a dedicated and detail-oriented Certified Case Manager to join our team. In this role, you will be responsible for preparing pre-authorizations for various medical services and conducting case reviews to ensure that all patient care plans align with medical guidelines and insurance requirements. You will work closely with healthcare providers, insurance companies, and patients to ensure a seamless process for approvals and reviews.
Key Responsibilities :
- Prepare and submit pre-authorization requests to insurance companies, ensuring all necessary documentation is included and follows the necessary guidelines.
- Review patient cases to ensure care plans are medically appropriate and align with insurance policies.
- Act as a liaison between healthcare providers, patients, and insurance companies to resolve any issues related to pre-authorization and care reviews.
- Maintain accurate and up-to-date records of all pre-authorization requests, approvals, and case reviews.
- Track the status of pre-authorization requests and ensure timely follow-ups.
- Analyze and interpret medical records and documentation to facilitate effective case reviews.
- Provide feedback and guidance to healthcare providers to ensure adherence to insurance requirements and proper documentation.
- Assist in the development and implementation of policies and procedures related to case management and pre-authorizations.
- Maintain confidentiality and adhere to all HIPAA guidelines.
Qualifications :
Preferred Qualifications :
Benefits :
