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Job Description
Job Summary
Ensures that timely, accurate and complete data is submitted to appropriate insurance companies to guarantee prompt payments to Spectrum Health. Communicates and collaborates with the multidisciplinary team through verbal and written communication. Participates with Care Team for the integration of the patient to the home or transitional environment by developing, planning, implementing and evaluating in accordance with current existing federal, state and local standards. Adheres to confidentiality policies specific to communications, patient confidentiality, record keeping and coordination services.
Essential Functions
Inputs data from various sources (insurance companies, admissions, certification, and other hospitals) into Care Management discharge planning software and insures communication to members of Care Team.
Processes and prepares clinical reviews completed by Care Management Department (CMD) employees for confidential transmission to third party payers.
Maintains ongoing communication between Spectrum Health (SH) and third party payers related to the number of hospital days authorized, additional requests for clinical information, anticipated discharge needs, etc.
Supports specific third party payers by obtaining authorization for services; providing accurate & timely admission/discharge dates; updating CMD and SH employees on any demographic changes; problem solving issues/concerns third party payer may have. Reports reviews needed to case manager.
Qualifications
Required High School Diploma or equivalent
Preferred Associate's Degree Business Administration, Management, Commerce, Communications, Public Relations or other related degree or equivalent combination of education and experience
2 years of relevant experience Related work in a clinical office or health insurance setting Required
Working in an organization of size and complexity comparable to Spectrum Health Required
Primary Location
SITE - Spectrum Health Butterworth Hospital - 100 Michigan St - Grand Rapids
Department Name
Care Management - Butterworth
Employment Type
Part time
Shift
Day (United States of America)
Weekly Scheduled Hours
20
Hours of Work
8 a.m. to 4:30 p.m.
Days Worked
Wednesday (every other), Thursday, Friday
Weekend Frequency
N/A
Accommodation Notice: If you are a qualified individual with a disability, you may request a reasonable accommodation in Spectrum Health's application process. Contact us at 616-486-SHHR (7447).
Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected
category. See more here (https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf) .
Who We Are
Spectrum Health is a nationally recognized not-for-profit health system, offering a full continuum of health services through our health plan, medical group and hospital group. As an integrated health system, we are able to work together across all facilities, employees and providers to create exceptional, consumer-focused interactions.
Spectrum Health is redefining what it takes to improve the health of our communities and introducing new and innovative ways for consumers to access high-quality, low-cost care so that they can connect with us for a lifetime of health.
We strive to provide one Spectrum Health experience: a consistent, high-quality, seamless health journey for consumers; no matter where, when or how they interact with us. The result is better health outcomes for the thousands of individuals, families and communities we serve.
We are the region's largest employer, with corporate offices located in Grand Rapids, Michigan. Spectrum Health Hospital Group and Spectrum Health Medical Group are consistently recognized for the exceptional care they provide. Priority Health is among the largest health system-sponsored health plans in the U.S. and offers extensive experience serving large and small employer groups, individuals, Medicare Advantage, Healthy Michigan Plan and Medicaid populations.
Since 2010, Spectrum Health has been listed five times among the 15 Top Health Systems in the U.S. by Truven Analytics™. Click here (https://www.spectrumhealth.org/about-us/quality-safety-and-patient-experience/awards) to see a complete list of our safety, quality and patient experience awards.
