The primary responsibility of this role is to review and process clinical documentation promptly and accurately to ensure proper reimbursement from contracted payors. This role will work with all department functions, and must have a thorough understanding of the reimbursement process, clinical guidelines and medical policies.
The Case Management Specialist is able to independently follow standardized workflows as defined by management. This is a skilled position that requires customer service and/or healthcare reimbursement experience and the ability to apply acquired skills to ensure the insurance claim is processed correctly and the company is able to successfully collect. The Case Management Specialist will be expected to work on a broad range of tasks including some more complex situations.