HCA Florida North Florida Hospital · 2 days ago
Insurance Case Manager
Gainesville, FL
Full-time
Onsite
Entry, Mid Level
2+ years expHCA Florida North Florida Hospital is part of HCA Healthcare, a leading provider of healthcare services. They are seeking an Insurance Case Manager to oversee transplant authorization and medical management authorization, acting as a liaison between clinical staff and hospital departments to address financial clearance matters.
Hospital & Health Care
Responsibilities
Oversee all aspects of transplant authorization and medical management authorization
Manage the transplant authorization process for assigned cases
Act as a liaison between clinical staff, physicians, and hospital departments to address escalated financial clearance matters
Completely and accurately obtains/maintains transplant benefits and insurance verification on patients presenting for transplant services and/or organ failure services during all phases of transplant care
Consistently meets deadlines and turn-around times to ensure authorizations are obtained timely
Manages all aspects of the transplant authorization process for assigned cases, which includes periodic re-verification of patients managed by the transplant program
Maintains and updates clinic and case management personnel on patient status, including patients who require additional testing for continued authorization, communication about authorization, and case closures with the insurance company
Assists with the development of processes and procedures related to the financial coordinator and/or counselor role in collaboration with the Department Director
Coordinates with clinicians to obtain authorizations for complex medical cases requiring additional clinical documentation or peer-to-peer review
Provides direction and support to Financial Coordinators and/or Financial Counselors on interpreting and understanding payor medical coverage policies and authorization requirements
Acts as a liaison to assist in maintaining effective relationships with clinical staff, physicians, and hospital departments by addressing escalated financial clearance matters
Supports the patient financial counseling process, which may include conducting patient education classes, financial counseling, and/or attending patient tracking meetings as designated
Coordinates with clinical case management, patient access, insurance case management, clinic personnel, and physicians to ensure transplant-related cases are reviewed for financial clearance, insurance selection, and authorization
Demonstrates proficiency in all areas related to Global Billing/Reimbursement for cross-coverage on duties that are not equally shared
Supports the mission and vision of the Methodist Healthcare System
Complies with System and facility safety policies and rules
Adheres to the MHS Code of Conduct and demonstrates ethical behavior
Completes other duties as assigned
Qualification
Required
Minimum of 2 years of direct experience with transplant financial clearance or clinical authorization with case management
College degree or 4 years of related work experience in a healthcare setting
Benefits
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
Free counseling services and resources for emotional, physical and financial wellbeing
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
Employee Stock Purchase Plan with 10% off HCA Healthcare stock
Family support through fertility and family building benefits with Progyny and adoption assistance.
Referral services for child, elder and pet care, home and auto repair, event planning and more
Consumer discounts through Abenity and Consumer Discounts
Retirement readiness, rollover assistance services and preferred banking partnerships
Education assistance (tuition, student loan, certification support, dependent scholarships)
Colleague recognition program
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
Company
HCA Florida North Florida Hospital
North Florida Regional Medical Center is now HCA Florida North Florida Hospital.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Kristy Redd-Hachey
Chief Financial Officer
Hannah Moore, SHRM-CP
HR Business Partner
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