Program Case Manager Consultant

San Francisco, CA

Posted: 05/21/2015 Employment Type: Contract Industry: Managed Care Job Number: 684


- Field inbound inquiries from client customers (hospitals, labs, ASCs, physician offices) about coding and billing (est.  25% of the time)

- Perform case management activities around PAs and appeals (est. 75% of the time), including:

> Establishing HIPAA clearance through BAA paperwork

> Conducting discovery with payers on PA and appeal channels,  requirements and timelines

> Customizing LMN and appeal letters from patient documentation (using established templates)

> Submitting to payers

> Communicating status with patients and providers

- Data entry into database

- Conduct activities according to established SOPs, work flows, and turnaround times

  Because most of the work will be case management, it' s not as much phone work as " traditional" hotlines. It' s a lot of independent activity  to work these cases and call payers when necessary for discovery. There is admin support to conduct follow up calls with payers (i.e., did you get the appeal packet?), call providers (i.e., can you send in  missing documents?), etc, so the contractor doesn' t need to do that type of activity.



- Professional phone skills

- Relational database use and some reporting experience

- Experience with health insurance billing, PAs, claim appeals, payer adjudication processes

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