Case Manager

Pediatric Services of America, Inc. Atlanta, GA
City: Atlanta

State: GA

Zip: 30328

Case Manager:

Job summary:

Provide a high level of individual patient management that encompasses comprehensive insurance

verification, authorization, adherence to contract guidelines and negotiation of profitable rates with noncontract

payers. Maintain a level of accountability and consistency with cases.

Activities:

Verify member eligibility and benefits with health insurance companies

Obtain all necessary medical records from Aveanna Locations and submit the information to the health

plan Case Manager to initiate the authorization process for nursing services and obtain

authorization or denial of services.

Seek clarification on benefits not clearly stated in benefit plan with lead representative or

supervisor.

Coordinate with member families and Aveanna Locations to ensure maximum benefits are available to

Aveanna patients

Negotiate rates for home health services when no contract applies

Maintain open communications with the Aveanna Locations on the status of obtaining authorization for

home health services.

Maintain open communications with the health plan case manager

Build and maintain payor relationships

Identify and adhere to payor specific requirements

Setup new patients in the Aveanna billing system

Communicate to Aveanna Locations the outcome of the request for authorization for services and

patient benefits

Coordinate with Aveanna's Third Party Liability team to manage coordination of benefits

Provide assistance to AR department as needed to help with high dollar claims issues.

Qualifications:

College Degree or equivalent experience

Minimum five (5) year prior Home Health Care experience

Minimum five (5) year prior experience in verifying eligibility and benefits for Home Health Services

Excellent oral and written communication skills

Ability to organize and prioritize responsibilities

Experience in Excel and Microsoft Word

Excellent interpersonal skills

Must demonstrate a positive attitude in a team environment

Physical Requirements:

1. Must be able to perform movements that regularly require repetitive use of the wrist(s), hand(s) and

or finger(s) approximately 80-90% of the workday

2. Finger dexterity to perform typing, picking up small objects, etc. approximately 80-90% of workday.

3. Must be able to verbally communicate instructions or other information as required approximately

80-90% of workday.

4. Must have adequate visual abilities to prepare, inspect documents or operate office machinery

approximately 100% of workday.

5. Must be able to exert physical strength and occasionally lift up to 25 pounds and/or frequently up to

15 pounds.

6. Must be able to hear average or normal tone conversations and understand/interpret noises or

spoken information.

7. Must be able to safely and properly drive vehicles.

8. Must be able to bend, turn/twist, kneel, squat 30-40% of each workday.

#Aveanna

Requisition ID: R0008853

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