MSA Outsourcing Solutions is a South African based Company focused predominantly in staffing for USA based clients. We provide high caliber staff, filling various roles in a multitude of industries across the USA. Our turnaround time is expedient, and everything is expected yesterday.
We are seeking an Authorization Specialist / Case Manager who are skilled to work hand-in-hand with our USA based clients, providing high-quality administration and enhancing their customer service experience.
Please note that the role will be office-based in Houghton Estate Johannesburg, operating during USA EST hours (3pm-12am daylight savings dependent).
Position Summary:
Responsibilities include ensuring timely and accurate submission of initial and continued Custodial Authorization requests reviews as indicated for inpatient Managed Medicaid population. Identifying, and communicating changes in financial coverage or status to Central Billing; Acting as a liaison between the SNF/LTC and Insurers. Collaboration with Social Workers, Care Transitions team, Physicians, and other Departments to ensure patient medical status is communicated and a safe discharge plan is developed where needed. Advocacy for patients medical status and continuation of coverage as necessary; Escalating Insurance Appeals as necessary. This position reports to the Regional Director of Case Management and may be required to supervise other staff personnel.
Essential Functions:
- Utilizes company software/systems effectively and appropriately.
- Completes all daily, weekly, monthly and annual reports according to corporate deadlines.
- Travels on-site to facilities as needed.
- Ensures accuracy of insurance coverage/authorizations.
- Audits the records of residents’ payer information and set up in the facility for accuracy.
- Attends weekly Authorization Review meetings
- Coordinates with the Central Billing Office as needed to resolve billing issues.
- Communicates with the Nursing team to resolve documentation issues.
- Works with facility social services department to ensure a safe discharge is arranged for when necessary
- Escalates and participates in the LTC Custodial auth insurance appeals process as needed.
- Adheres to budget guidelines and assists with annual Business Office budget.
- Ensures that all proprietary, financial, and resident information is kept confidential.
Non-Essential Functions:
- Attends all required training, in-service, and staff meetings.
- Strives to maintain a safe working environment through the prevention of accidents, the preservation of equipment, and the achievement of safe working practices.
- Maintains a positive and professional demeanor toward residents, visitors, families, and co-workers and outside vendors.
- Adheres to all policies and procedures of Spring Hills, LLC.
- Performs other duties as assigned.
Skills:
- Active Listening - Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
- Knowledge of medical terminology required.
- Management of Personnel Resources - Motivating, developing, and directing people as they work, identifying the best people for the job.
- Writing - Communicating effectively in writing as appropriate for the needs of the audience.
- Reading Comprehension - Understanding written sentences and paragraphs in work related documents.
- Speaking - Talking to others to convey information effectively.
- Negotiation - Bringing others together and trying to reconcile differences.
- Mathematics - Using mathematics to solve problems.
- Time Management - Managing one's own time and the time of others.
- Critical Thinking - Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
- Active Learning - Understanding the implications of new information for both current and future problem-solving and decision-making.
Attributes:
- Oral Comprehension - The ability to listen to and understand information and ideas presented through spoken words and sentences.
- Oral Expression - The ability to communicate information and ideas in speaking so others will understand.
- Written Expression - The ability to communicate information and ideas in writing so others will understand.
- Written Comprehension - The ability to read and understand information and ideas presented in writing.
- Speech Recognition - The ability to identify and understand the speech of another person.
- Speech Clarity - The ability to speak clearly so others can understand you.
- Near Vision - The ability to see details at close range (within a few feet of the observer).
- Mathematical Reasoning - The ability to choose the right mathematical methods or formulas to solve a problem.
- Problem Sensitivity - The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.
- Deductive Reasoning - The ability to apply general rules to specific problems to produce answers that make sense.
- Information Ordering - The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations).
Experience and Education:
- A Bachelor’s Degree from a four-year college or university;
- At least three years of experience in Managed Care, including insurance verification involving the communication of pertinent medical information required.
- Working knowledge of CMS Chapter 8 guidelines
- Strong working knowledge of New Jersey Medicaid LTC/MLTSS Guidelines and clinical requirements
- Background in admitting, financial, or business office in a Sub-acute or LTC Rehab setting preferred.
Job Type: Full-time
Pay: R12 000.00 - R15 000.00 per month
Work Location: In person
Pay: R12 000,00 - R15 000,00 per month
Work Location: In person
