Case Management Assistant, Reverse Access Center

Job description

Job Requirements
The University of Maryland Access Center (UMAC) Reverse Access Center (RAC) program is a high-priority corporate effort that is focused on improving collaboration and coordination with Post-Acute Care (PAC) flow. The goal of RAC is to centralize the insurance pre-authorization functionality, denials tracking processes, and data on payers and post-acute vendor facilities for all UMMS member orgs.
Under moderate supervision, performs non-clinical tasks by optimizing the current module workflows to support member organizations with patient discharge by getting pre-authorization. Tracks insurance denials and compile data for dashboards that allow University of Maryland Medical System (UMMS) member organizations to have better awareness on vendors and payers. This role learns multiple UMMS member organizations workflows, establishes working relationships with their teams, and processes specific identified data for those sites that inform possible performance improvement opportunities.
Primary Responsibilities
1. Insurance Authorization
• Maintain an up-to-date patient list and inbasket for patients referred to RAC from UMMS member organizations.
• Lead the centralized prior authorization for the PAC admission; coordinate with UMMS case management teams to ensure finalized clinical documents are obtained for insurance review.
• Inputs and updates all pertinent information and data in the EMR.
• Coordinate denial and appeal management for PAC as it effects UMMS, including the peer review process
• Provide PAC bed availability to care management stakeholders across UMMS.
• Perform other duties as assigned.

2. Data Collection and Monitoring
• Engage with the UMAC Director of Data Analytics and Technology Innovation to ensure that the CMA workflows align with the data capturing.
• Monitor data dashboards for accuracy and support performance improvement activities based on the key performance indicator data.

Work Experience
Education & Experience - Required
• High school diploma or equivalency.
• 2 years’ experience in healthcare, or related field.
• Electronic Medical Record (EMR) and insurance authorization experience preferred.

Knowledge, Skills, & Abilities
• Familiarity with medical terminology.
• Familiarity with insurance processes.
• Demonstrated ability to perform basic mathematical calculations including percentage, addition, subtraction, multiplication, and division.
• Ability to use a calculator.
• Ability to operate a computer, with working knowledge of the keyboard configuration.
• Ability to maintain confidentiality with patient and team member information.
• Ability to work independently with minimal supervision.
• Demonstrated resourcefulness, with ability to anticipate needs, prioritize responsibilities and take initiative.
• Detail oriented and ability to meet established deadlines.
• Effective skill managing multiple staff initiatives/priorities and meeting changing requirements and priorities to accomplish objectives.
• Effective skill developing and maintaining collaborative working relationships with all levels of leadership and staff.
• Effective analytical, conceptual thinking, planning, organizational, and problem-solving skills.
• Effective skill in the use of Microsoft Office Suite (e.g., Access, Excel, Word, Outlook, etc.).
• Effective verbal, written and interpersonal communication skills.