Case Management Specialist, Care Coordination, Bethesda East, FT, 08 : 30A-5P

Baptist Health Care Management Coordinator

Is responsible for the coordination of information between the Care Management Department and Third Party Payors (Insurance Companies). Assures timely submission of utilization reviews for the hospital in order to effect proper reimbursement from insurance companies and prevent denials. Is the departments liaison between insurance companies and the Care Manager in response to insurance requests for clinical reviews / authorizations. Maintains effective working relationships with insurance companies through ongoing communication and collaboration. Works in conjunction with Access Management and Patient Financial Services to assure accurate and timely submission of clinical reviews for appropriate reimbursement. Directs any potential denials to the Denials Coordinator and assists with the submission of missing documentation to insurance companies when necessary. Responsible for key business functions including creating and maintaining staffing schedules, managing payroll, inventory management, purchasing and invoicing. Uses effective communication skills to provide support in disseminating information to the staff. Supports operational initiatives and projects providing regular informational reports analysis and organizing data for utilization review management.

Qualifications : Degrees :

• Associates.

Additional Qualifications :

Minimum Required Experience :

EOE, including disability / vets