New job Medicare Coordinator- FT in South Dakota

Medicare Coordinator- FT

Company : Fall River Health Services
Salary : Details not provided
Location : South Dakota

Full Description

Medicare Coordinator- FT

Role Summary-
The Medicare Coordinator is responsible for enhancing and maintaining a properly functioning admission/discharge process through a cross-department organizational structure. These functional areas act interdependently during a patient visit, contributing critical information required for clinical service and procuring payment.

MINIMAL QUALIFICATIONS:

Education: Must have a current SD RN license.
Work Experience: Prefer a minimum of three to five years of experience in healthcare that demonstrates case management or social work experience.

Previous experience to include:
  • In-depth knowledge of hospital and physician billing and reimbursement
  • Understanding of private insurance authorization process
  • Experience with total quality management concepts and tools
  • Working knowledge of the areas of the patient admission process, registration, managed care contractual terms and requirements, health insurance practices and industry regulatory requirements.
  • Ability to analyze and resolve problems that affect the claim submission process, regardless of whether the problem originates in an area under direct or indirect control
  • Leadership skills to motivate cross-departmental teams’ performance towards excellence and develop team concepts.
  • The ability to make a significant contribution to the organization’s overall effectiveness.

ESSENTIAL FUNCTIONS Include:

Medicare utilization and program compliance.
Admission/Discharge Planning
Perform admission prior authorizations with private insurance, confirming patient’s coverage and benefits.
Participate in revenue cycle and denial management.
Ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
Identifies each patient needs for medically related social services and pursues the provision of these services.
Case management of selected patients to enhance overall patient health and to ensure proper navigation of the total healthcare system.
Utilize team member’s expertice to create patient centered goals.
Act as a patient’s advocate through the entire hospital admission.
Carries out other assignments or special projects as assigned.
Work hours are Monday thru Friday, 8am-4:30pm.

Contact Information
Human Resources - Human Resources Manager
Human Resources
Email: mlargent@frhssd.org
Phone: 605-745-3159 ext 2328

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Source : Indded