Insurance Case Manager LPN

This is a full time position work from home position.

Job Responsibilities:

• Provides care coordination for home health and hospice patients according to internal policy and external payer guidelines.
• Logs all communication notes into applicable patient database system.
• Reviews insurance authorization for third party reimbursement, recertifies and updates field staff and insurance companies about patient status for continued care and notifies appropriate staff regarding insurance authorization status.
• Manages capitated contracts according to internal policy, striving to meet care objectives in a cost-effective manner.
• Maintains current knowledge of reimbursement policies including Medicare, Medicaid, private pay and commercial payer contracts.
• Facilitates communication between staff members to promote a team effort within the agency.
• Participates in facility surveys organized by authorized regulatory and accrediting bodies.
• Functions as a liaison between the patient and the referral source.
• Assists with the collection process by reviewing all denials due to lack of insurance authorization or payer issue.
• Performs other related duties as assigned.

Education:

• Graduate of an accredited practical nursing program

Languages:

• English

Certifications:

• State of Ohio LPN license

Competencies (Complexity of Work):

• Thorough knowledge of Insurance/Medicare/Medicaid regulations and requirements for coverage of patient care.
• Proficient with computer skills including working in a Windows environment.
• Ability to type 25 wpm preferred. Strong organizational and communication skills.
• Must be able to exercise independent judgement in interactions with physicians, payers, patients, and their families.

Work Experience:

• Two years acute care experience.
• Two years of home health or hospice experience preferred.
• One year experience with insurance verification/pre-certification/case management preferred.

Physical Requirements:

• Requires sitting, standing and walking for extended periods of time.
• Requires manual dexterity to perform work on a PC.
• Requires good visual acuity through normal or corrected vision
• Must be able to hear typical conversation levels through normal or corrected hearing

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment as required.

Keywords: LPN, insurance authorization, licensed practical nurse, pre-certification